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Another State Promotes the Pseudoscientific Cult that is “Naturopathic Medicine.” Part 4

The “Science” and Ethics of “Natural Medicines” (and Nutrition) cont.

This is the continuation of a discussion concerning the explicit claim of “naturopathic physicians”* to being experts in the use of “natural medicines,” defined as “medicines of mineral, animal and botanical origin.” Last week’s post established that the cult has chosen to profit from the “retail selling of medications,” as evidenced by the relevant Position Paper of the American Association of Naturopathic Physicians (AANP) and by that organization’s having made a deal with a drug company to make profits for both itself and its members.

The Position Paper observes that such selling “could be construed as a conflict of interest on the part of the physician.” That is true, if embarrassingly understated: anyone representing himself as a physician, who both recommends and sells the same medications for a profit, has conflicting interests. The conflict undermines his claim to offering responsible advice regarding those medications, and as such is a breach of medical ethics.

The AANP’s deal with MotherNature.com was even worse: by promoting such peddling in a formal, institutional fashion, NDs and their national organization went beyond the already widespread problem of practitioners hawking drugs. It is unclear whether the deal still exists, by the way: MotherNature.com was a victim of the “dot com” bust of a few years ago. It has since been resurrected, but a quick perusal of its new website fails to reveal the old AANP relationship. Nevertheless, I have seen no evidence to suggest that the AANP has changed its view of that sort of deal.

Are NDs Truly “Learned Intermediaries” in the Use of “Natural Medicines?”

This entry discusses the other part of the claim of expertise: that, aside from their conflicting interests, NDs have real knowledge of “natural medicines.” It will become clear during the discussion that the purported naturopathic expertise in nutrition—another standard claim—is also under review. I will include or cite abundant evidence for my assertions, because I’ve found that a predictable response of representatives of the highest levels of “naturopathic medicine” is to flatly deny them. I apologize again for including excerpts from previously published material.

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Posted in: Book & movie reviews, Health Fraud, Herbs & Supplements, Medical Ethics, Nutrition, Politics and Regulation

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The Bait and Switch of Unscientific Medicine

Savvy consumers are familiar with the classic scam of the “bait and switch” – in practice if not the term itself. My wife and I ran across it when we were shopping for our first car. We needed a bargain and so we were attracted to the ads that promised a new Colt for only $9,000 (that’s the bait). Of course when we got to the dealership they were all out of Colts with the configuration advertised, but they had plenty of others that had different options that cost several thousand dollars more (that’s the switch).

It’s a basic and very successful form of deception, and so even though there are laws against such practices it is impossible to eliminate in all its various and more subtle forms. It even permeates scientific, political, and other intellectual endeavors – anytime a more palatable idea or claim is put forward to represent the less acceptable truth.

Science, however, requires transparent honesty to function properly, and therefore scientific practitioners must vigilantly guard against the cognitive bait and switch. Generic intellectual virtues incorporate this vigilance – they include the need to unambiguously define terms, to make claims as specific and operational as possible, and the use of valid logic. Beware of any claims that subtly violate these rules because they are probably setting you up for a bait and switch.

The purveyors of unscientific medical claims have become as expert at this classic deception as the slickest used-car salesman – in fact they have left the hawkers of dubious transportation in the dust.

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Posted in: Health Fraud, Science and Medicine

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Chiropractic Strokes Again! A Landmark Lawsuit in Canada

Sandra Nette is a prisoner, condemned to spend the rest of her life in the cruelest form of solitary confinement. Her intact mind is trapped in a paralyzed body and she is unable to speak. She can move one arm just enough to type on a special keyboard. She cannot swallow or breathe on her own, and must be frequently suctioned. She feels sensations and is in pain. Her condition is known as “locked-in syndrome” and has been described as “the closest thing to being buried alive.” She is suing those responsible for her cruel fate and I hope she wins.

She was a healthy 40 year old woman who wanted to stay healthy. She did all the right things like watching her weight, eating right, and not smoking. She followed the advice of a chiropractor to include regular maintenance chiropractic adjustments in her health regimen. On September 13, 2007 she had the last adjustment she would ever have.

There was nothing wrong with her. She didn’t see the chiropractor for headaches, neck pain, back pain or any other complaint. She went for a “tune-up” that she thought would help keep her healthy. The chiropractor did a rapid-thrust adjustment on her neck. Right afterwards, she complained of feeling “sore, dizzy and unwell.” She tried to leave but had to sit down. The chiropractor failed to recognize the medical emergency, and instead of calling an ambulance he recommended that she would benefit from purchasing massage therapy from his clinic. He let her leave the office and drive home alone. She only made it part way. (more…)

Posted in: Chiropractic, Health Fraud, Politics and Regulation

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Another State Promotes the Pseudoscientific Cult that is “Naturopathic Medicine.” Part 3

The “Science” and Ethics of “Natural Medicines”

This and the next entry in the current “Naturopathic Medicine” series* deal with the cult’s claim of expertise in “natural medicines” or “natural remedies.” These include herbs (“botanicals”), glandular extracts, vitamins, and minerals. A large fraction of the Textbook of Natural Medicine (TNM), “the most thoroughly researched and carefully referenced text on natural medicine,” is devoted to these agents.[1] They are keys to the practice of naturopathy and to a core claim of “naturopathic physicians” that legislators tend to swallow: that NDs offer something that most MDs do not.

During the deliberations of the Massachusetts Special Commission, NDs produced Dr. Alan Trachtenberg, a fresh-faced ingenue who had briefly been Acting Director of the federal Office of Alternative Medicine, to testify on their behalf. He suggested to the Commission that naturopaths could be the “learned intermediaries” that the public needed to help make sense of the myriad “natural remedies” that became freely available in the wake of the Dietary and Supplement Health and Education Act of 1994 (DSHEA). This is from his written testimony:

Another advantage of state licensure, is that the holder of a professional license who provides or recommends a product, then becomes responsible for the quality and safety of a product. In an unregulated marketplace, such a learned intermediary can be invaluable to the consumer. Since naturopaths do often provide dietary supplements and herbal products directly to their patients, it is vital that they have an enforceable code of professional ethics. Such a code of ethics becomes enforceable with State licensure.

It is also beneficial for the patient to have a practitioner who knows enough about biochemistry, physiology, pharmacology, and physical diagnosis to adequately assess a patient’s clinical response to a product. These products are essentially complicated but unregulated drug mixtures. My understanding is that licensable naturopathic doctors have all taken these courses during their four years of training and passed standardized exams that test their mastery. There is no such quality assurance for the other kind of naturopathic practitioner.

Instead of relying on Dr. Trachtenberg’s “understanding,” let’s submit his two assertions—that of a “code of ethics” and that of “mastery” of the topic of “natural medicines”—to real scrutiny. In doing so I confess that I have plagiarized, to some extent, pieces that I’ve written elsewhere.

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Posted in: Health Fraud, Herbs & Supplements, Medical Ethics, Politics and Regulation

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Another State Promotes the Pseudoscientific Cult that is “Naturopathic Medicine.” Part 2

The “Safety of Naturopathic Treatment”

In their nationwide effort to convince lawmakers to pronounce them primary care physicians, “educated” naturopaths have repeatedly claimed that their “natural” treatments are “safer and gentler” than those offered by medical doctors. The Alliance Legislative Workbook, a website that for several years provided strategies and “talking points” for ND-activists seeking state licensure, made this assertion in 2001:

Malpractice insurance rates [for licensed NDs] are generally less than $4000.00 per year, indicating the safety of naturopathic treatment as assessed by insurance companies. Master Insurance Trust reports that of the naturopathic physicians for whom MIT provides liability insurance, there have been only four incidents reported to the company for follow-up. However, nothing has been paid in either settlements or judgements on any of these items. “While this pooling of physicians is much too small to base actuarial considerations, this claims experience is clearly superior.” (Jeffrey D. Brunken, Program Manager, MIT, Letter dated May 21, 1990.)

Jury Verdicts Northwest, a legal database which records court cases in Washington and Oregon, the area of the country with the largest number of naturopathic physicians, shows no judgments for malpractice against N.D.s since the database was started in 1983. One in five M.D.s is sued each year in the US (AMA).

Why is malpractice so much lower among naturopathic physicians?

Naturopathic methods are less likely to cause injury than orthodox methods. Prudent dietary and lifestyle changes, for instance, are unlikely to cause harm. Naturopathic physicians by philosophy and training use the least invasive means to treat and prevent disease. This results in less injury to patients. Naturopathic physicians also have excellent diagnostic and referral skills. There is no significant history of complaints against naturopathic physicians resulting from a missed diagnoses, the most common cause for suits in a general practice. From insurance data, it appears that naturopathic physicians as a group know the limits of their methods and refer patients to other practitioners or specialists when appropriate.

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Posted in: Health Fraud, Politics and Regulation, Science and Medicine

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The FDA Cracks Down on Fake Cancer Cures

The Food and Drug Administration (FDA), the agency that regulates the drug industry in the US, put out a press release yesterday warning “Individuals and Firms to Stop Selling Fake Cancer ‘Cures’.” The press release reports:

“Although promotions of bogus cancer ‘cures’ have always been a problem, the Internet has provided a mechanism for them to flourish,” said Margaret O’K. Glavin, the FDA’s associate commissioner for regulatory affairs. “These warning letters are an important step to ensure that consumers do not become the victim of false ‘cures’ that may cause greater harm to their health.”

The FDA therefore recognizes that this is a serious problem, and that is good. They also acknowledge that the problem of “bogus cancer cures” is a longstanding one, not a new or recent problem, but the reason they are taking action now is because the internet is significantly increasing the reach of these fake cures.

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Posted in: Cancer, Health Fraud, Politics and Regulation

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Another State Promotes the Pseudoscientific Cult that is “Naturopathic Medicine.” Part 1

Minnesota has recently become the 15th state in the U.S. to formally endorse the claims of a tiny group of naturopaths who portray themselves as physicians.* The bill , like the popular-media “CAM” reports that Steve Novella criticized on Wednesday, merely parrots what these naturopaths claim about themselves. It reveals no attempt to investigate or to judge the tenets of the field. The following excerpts present false assertions as though they were facts. I’ve underlined some of the more obvious examples:

“Naturopathic medicine” means a system of primary health care for the prevention, assessment, and treatment of human health conditions, injuries, and diseases

“Naturopathic physical medicine” includes, but is not limited to, the therapeutic use of the physical agents of air, water, heat, cold, sound, light, and electromagnetic nonionizing radiation and the physical modalities of electrotherapy, diathermy, ultraviolet light, hydrotherapy, massage, stretching, colon hydrotherapy, frequency specific microcurrent, electrical muscle stimulation, transcutaneous electrical nerve stimulation, and therapeutic exercise.

The practice of naturopathic medicine includes, but is not limited to, the following services: (1) ordering, administering, prescribing, or dispensing for preventive and therapeutic purposes: food, extracts of food, nutraceuticals, vitamins, minerals, amino acids, enzymes, botanicals and their extracts, botanical medicines, herbal remedies, homeopathic medicines, dietary supplements and nonprescription drugs as defined by the federal Food, Drug, and Cosmetic Act, glandulars, protomorphogens, lifestyle counseling, hypnotherapy, biofeedback, dietary therapy, electrotherapy, galvanic therapy, oxygen, therapeutic devices, barrier devices for contraception, and minor office procedures, including obtaining specimens to assess and treat disease

Unlike the Minnesota leglislators, I have substantial knowledge of the tenets and practices of “naturopathic physicians,” and I am capable of judging those tenets according to standards of reason, science, and modern, science-based medicine. Beginning with my stint on the Massachusetts Special Commission on Complementary and Alternative Medical Practitioners 6-8 years ago, I have spent years listening to “NDs,” reading their literature, and writing about them. I described a bit of my experience on that Commission in a post on Science-Based Medicine several weeks ago. I have continued to observe NDs’ cult-like behavior since then, and have seen no indication that they have begun to awaken from their collective, pseudoscientific stupor.

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Posted in: Health Fraud, Politics and Regulation, Vaccines

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Mercury Must Be Bad – If Not in Vaccines, In Teeth

Those of us who are baby boomers or older can remember playing with mercury when we were young. The thermometer broke, and you pushed the little globules around. Or you fooled around with the stuff in science class. My husband says he used to get mercury to flow over the surface of a dime and make it look really shiny. Who knew our old playmate would turn out to be such a bugaboo?

The real dangers of mercury have been recognized. Guidelines have been published to limit exposure. Instructions for safe cleanup of mercury spills are available online. This is good. Other developments are not so good. Scaremongers have demonized mercury and blamed it for everything from autism to Alzheimer’s.

Just when you thought the mercury/autism scare was finally subsiding, another mercury scare has resurfaced. The alarm has been raised (again!) about the mercury in amalgam fillings. (more…)

Posted in: Dentistry, Health Fraud, Politics and Regulation, Science and the Media

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Touched by a Touched Healing Toucher

Recent posts by Drs. Sampson and Hansen and some recent comments have got me to thinking for the umpteenth time about this issue: quackery is quackery, even if it seems harmless and even if some people seek it. This is the first of a series that will discuss it. I’m afraid I will ramble a bit; it may be that not every post will support that premise. Nevertheless, in the aggregate I’ll try to do exactly that.

The posts about Healing Touch sent me on a walk down memory lane, to one of my early forays into “CAM” skepticism. It was there that I discovered just how removed from reality some true believers, even those that project a superficial air of sobriety, can be. Here I’ll recount a brief exchange that I had with one such person, who was undoubtedly well-meaning. My attempts to influence her by the use of reason proved futile.

Shortly after the publication of the famous Emily Rosa article in 1998, I read a report about it in Newsday. It wasn’t all that bad, but my annoyance with mainstream publications giving the slightest credence to “alternative medicine” had been growing, and this moved me to act. I wrote a diatribe to Newsday that was not published (I can’t imagine why):

To the Editor:

“Therapeutic touch” is such obvious humbug that it never should have been taken seriously by anyone with the slightest aquaintance with how things work. Nevertheless, academic careers have been based on it, hundreds of useless papers have been written about it, courses in it have been given and even required of nursing students, grant money has been provided for it (but not used to test it!), and scores of ridiculous magazine and newspaper articles have praised it, apparently to a naive and credulous public. All of this constitutes a huge embarrassment to nurses, a fact that would appear to be lost on their largest professional organization (the ANA).

One of the statements in your article about the JAMA study was incorrect: the practitioners were not able to detect the energy field half of the time. They were able to guess the correct hand half the time, as would be predicted by chance alone. Thus there is no evidence that the “energy field” was detected at all. This is no surprise, because this kind of “energy field” exists only in the fantasies of true believers.

Dolores Krieger’s objection to the study, that the right practitioners were not tested, is disingenuous. She has been asked numerous times, by James Randi and others, to submit to testing of the same sort as described in Rosa’s study (Randi’s foundation has even offered a $1 million reward for anyone who can demonstrate the ability to detect the “energy field”!). Neither she nor any of her trainees or colleagues has come forward, nor has any of them published a single study supporting the efficacy of “therapeutic touch.”

Among the shamelessly fawning, uncritical articles on TT referred to above is one in Newsday by Tina Morales, 7/8/96. Really, now. There are very simple, basic skills useful for evaluating questionable claims. If the writer doesn’t have them the editor certainly should!

Before gentle readers admonish me for the scolding, schoolmarmish tone of that letter, let me assure them that I have long since learned to couch my objections to “woo” in more matter-of-fact, less provocative language. As frustrating as it may be, amiable, well-meaning, intelligent people who haven’t the slightest idea how to evaluate questionable claims vastly outnumber their more savvy counterparts, even in surprising fields: journalism and medicine, for example. Ten years ago I had no intention of becoming more than a temporary, annoying gadfly. I imagined that the “CAM” fad would soon blow over, and that I’d go back to spending my free time watching re-runs of Seinfeld and Law and Order. Alas, ’twas not to be. Patience.

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Posted in: Energy Medicine, Faith Healing & Spirituality, Health Fraud

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“Chelation Therapy”: Another Unethical “CAM” Trial Sponsored by Taxpayers

Please forgive the promotion of our own work and the facile evasion of a full-length blog, but two of your faithful bloggers are co-authors of an article published this week:

Why the NIH Trial to Assess Chelation Therapy (TACT) Should Be Abandoned

Kimball C. Atwood IV, MD; Elizabeth Woeckner, AB, MA; Robert S. Baratz, MD, DDS, PhD; Wallace I. Sampson, MD

Medscape J Med.  2008;10(5):115.  ©2008 Medscape

Posted 05/13/2008

Available here.

You may be asked to “register”; don’t worry, it’s free. The article is very long, but the Introduction, Executive SummaryDiscussion, and Conclusion are reasonably succinct and make the important points. Readers who want to learn more details, who want to see more evidence for our assertions, or who are compelled by an odd fascination with crackpotism (my own weakness) will want to read more. Here is a small sample:

Abstract

The National Institutes of Health (NIH) Trial to Assess Chelation Therapy (TACT) was begun in 2003 and is expected to be completed in 2009. It is a trial of office-based, intravenous disodium ethylene-diamine-tetra-acetic acid (Na2EDTA) as a treatment for coronary artery disease (CAD). A few case series in the 1950s and early 1960s had found Na2EDTA to be ineffective for CAD or peripheral vascular disease (PVD). Nevertheless, a few hundred physicians, almost all of whom advocate other dubious treatments, continued to peddle chelation as an office treatment. They claim that chelation dramatically improves symptoms and prolongs life in 80% to 90% of patients. In response, academics performed 4 controlled trials during the 1990s. None favored chelation, but chelationists repudiated those findings.

We have investigated the method and the trial. We present our findings in 4 parts: history, origin and nature of the TACT, state of the evidence, and risks. We present evidence that chelationists and their organization, the American College for Advancement in Medicine, used political connections to pressure the NIH to fund the TACT. The TACT protocols justified the trial by misrepresenting case series and by ignoring evidence of risks. The trial employs nearly 100 unfit co-investigators. It conflates disodium EDTA and another, somewhat safer drug. It lacks precautions necessary to minimize risks. The consent form reflects those shortcomings and fails to disclose apparent proprietary interests. The trial’s outcome will be unreliable and almost certainly equivocal, thus defeating its stated purpose.

We conclude that the TACT is unethical, dangerous, pointless, and wasteful. It should be abandoned.

Readers of my postings on SBM will find more discussion (and abundant evidence) of familiar material: ethical breaches resulting from political incursions into science; the pitfalls, both scientific and ethical, of ignoring prior probability; a Dirty Secret of the Extraordinary Popular Delusion that is “CAM,” that much of what masquerades as sober research or the practice of “integrative medicine” was spawned by Laetrile; and widespread dishonesty in “academic CAM.”

Medscape Journal of Medicine invites readers to post comments or to send private letters to the editor for potential publication (and replies by yours truly, in this case). If you are so moved, you might consider posting comments in duplicate, both there and here on SBM, for the benefit of our select readership.

Posted in: Clinical Trials, Health Fraud, Medical Ethics, Politics and Regulation

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