March 4, 2010
Today I went to the one-day, 2nd Yale Research Symposium on Complementary and Integrative Medicine. Many of you will recall that the first version of this conference occurred in April, 2008. According to Yale’s Continuing Medical Education website, the first conference “featured presentations from experts in CAM/IM from Yale and other leading medical institutions and drew national and international attention.” That is true: some of the national attention can be reviewed here, here, here, and here; the international attention is here. (Sorry about the flippancy; it was irresistible)
I’ve not been to a conference promising similar content since about 2001, and in general I’ve no particular wish to do so. This one was different: Steve Novella, in his day job a Yale neurologist, had been invited to be part of a Moderated Discussion on Evidence and Plausibility in the Context of CAM Research and Clinical Practice. This was not to be missed.
The House of Commons Science and Technology Committee (STC) has released a report, Evidence Check 2: Homeopathy, in which they recommend that the NHS stop funding homeopathy. The report is a rare commodity – a thoroughly science-based political document.
The committee went beyond simply stating that homeopathy does not work, and revealed impressive insight into the ethical, practical, and scientific problems caused by NHS support for an implausible and ineffective pseudoscience.
The STC formed in October of 2009, and this is their second report. The goals of the STC itself are significant step forward:
The purpose of Evidence Check is to examine how the Government uses evidence to formulate and review its policies.
We certainly can use more of that.
A MISCARRIAGE OF JUSTICE THAT HAD A (SORT OF) HAPPY ENDING
Back in September and then again last week, I wrote briefly (for me) about an incident that I considered to be a true miscarriage of justice, namely the prosecution of two nurses for having reported the dubious and substandard medical practices of a physician on the staff of Winkler County Hospital in Kermit, Texas. The physician’s name is Dr. Rolando Arafiles, and he happened to be a friend of the Winkler County Sheriff, Robert Roberts, who also happened to have been a patient of Dr. Arafiles and very grateful to him for having saved his life. The nurses, Anne Mitchell and Vickilyn Galle, were longtime employees of Winkler County Hospital, a fifteen bed hospital in rural West Texas. Although some of you may have seen extensive blogging about this before, I thought it very important to discuss some of the issues involved on this blog. Moreover, there is an aspect to this case that the mainstream media reporting on it has missed almost completely, as you will see. Finally, this case showed me something very ugly about my profession, not just because a doctor tried to destroy the lives of two good nurses through his connections to the good ol’ boy network in Winkler County
Let’s recap what happened, a story that reached its climax last Thursday. In 2008, Dr. Arafiles joined the staff of Winkler County Hospital (WCH). It did not take too long for it to become apparent that there were serious problems with this particular doctor. Mitchell and Galle, who worked in quality assurance were dismayed to learn that Dr. Arafiles would abuse his position to try to sell various herbal remedies to patients in the WCH emergency room and the county health clinic and to take supplies from the hospital to perform procedures at a patient’s home rather than in the hospital. No, it wasn’t the fact that Dr. Arafiles recommended supplements and various other “alt-med” remedies, it’s that he recommended supplements and various other “alt-med” remedies that he sold from his own business–a definite no-no both ethically and, in many states, legally. Mitchell reported her concerns to the administration of WCH, which did pretty much absolutely nothing. Consequently, on April 7, 2009, Mitchell and Galle anonymously reported their concerns to the Texas Medical Board (TMB). In June, WCH fired the two nurses without explanation.
One of the claims most frequently made by “alternative medicine” advocates regarding why alt-med is supposedly superior (or at least equal) to “conventional” medicine and should not be dismissed, regardless of how scientifically improbable any individual alt-med modality may be, is that the treatments are, if you believe many of the practitioners touting them, highly “individualized.” In other words, the “entire patient” is taken into account with what is frequently referred to as a “holistic approach” that looks at “every aspect” of the patient, with the result that every patient requires a different treatment, sometimes even for the exact same disease of very close to the same severity. Indeed, as I have described before, a variant of this claim, often laden with meaningless pseudoscientific babble about “emergent systems,” is sometimes used to claim that the standard methods of science- and evidence-based medicine are not appropriate to studying the efficacy of alternative medicine. Of course, this is, in nearly all cases, simply an excuse to dismiss scientific studies that fail to find efficacy for various “alt-med” modalities, but, even so, it is a claim that irritates me to no end, because it is so clearly nonsense. As Harriet Hall pointed out, alt-med “practitioners” frequently ascribe One True Cause to All Disease, which is about as far from “individualization” as you can get, when you come right down to it. More on that later.
A couple of years ago, before I became involved with this blog, I was surprised to learn that even some advocates of alt-med have their doubts that “individualization” is such a great strength. I had never realized that this might be the case until I came across a post by naturopath Travis Elliott, who runs a pro-alt-med blog, Dr. Travis Elliott and the Two-Sided Coin, entitled The Single Most Frustrating Thing About (Most) Alternative Medicine. In this article, Elliott referred to a case written up by a fellow naturopath, who used an anecdote about the evaluation and treatment plan by a naturopath of a pregnant woman with nausea to show what is supposedly the “unique power of our medicine.” Unexpectedly (to me at least at the time), Elliott did not quite see it that way:
If there’s one thing about the so-called “complementary and alternative medicine” (CAM) movement that I’ve emphasized time and time again, it’s that its adherents have a definite love-hate relationship with science. They hate it because it is the single greatest threat to their beliefs system and the pseudoscience that underlies it. At the same time, they crave the legitimacy that science confers. They crave it not because they have any great love for science. Quite the contrary. It is simply that they recognize that science actually delivers the goods. Of course, they believe that they deliver the goods too, but they come to this belief not through science but rather through all the cognitive shortcomings and biases to which humans are prone, such as confusing correlation with causation, confirmation bias, not recognizing regression to the mean, and being fooled by the placebo effect. Whether it’s through a misunderstanding of science or less innocent reasons, they go to great lengths to torture it into superficially appearing to support their claims through a combination of cherry-picking of studies that seem to support them and misrepresenting ones that don’t, discussions of which abound right here in this very blog.
The other thing I’ve emphasized about the CAM movement is that, even more than scientific credibility, they crave legitimacy. To them, however, science is but one pathway to legitimacy, because, unlike practitioners of science-based medicine, they are more than willing to bypass science to obtain the legitimacy–or at least the appearance of the legitimacy–they so crave. If it means doing an end run around science by trying to hijack the Obama health insurance reform bill that is currently being negotiated to resolve the differences between the Senate and House versions, so be it. Indeed, earlier this year, I described how Senator Tom Harkin has tried to promote CAM through the National Center for Complementary and Alternative Medicine (NCCAM) and trying to insert provisions into the bill that would mandate that government-subsidized insurance exchanges pay for CAM. Meanwhile, prominent CAM advocates have been carpet-bombing the media with dubious arguments in support of CAM, as in when Deepak Chopra, Rustum Roy, Dean Ornish, and Andrew Weil teamed up in different combinations to promote the idea that CAM is all about “prevention” and that science-based medicine, in all its reductionistic evil, is nothing more than pushing pills.
They’re at it again.
Homeopathy, as a cultural phenomenon, remains an enigma. In the two centuries since its invention it has failed to garner significant scientific support. In fact, developments in physics, chemistry, biology, and medicine have shown the underlying concepts of homeopathy to be wrong – guesswork and speculation that lept in the wrong direction.
It turns out, like does not cure like. This is nothing more than sympathetic magic – popular at the time but now considered nothing more than superstition without any scientific basis.
It also turns out that diluting a substance does not make it more potent – this nonsensical idea (ridiculed even in the 19th century) violates the laws of thermodynamics, and the chemical principle of mass action. This is especially true when you dilute a substance beyond the point where chance would have even a single molecule of active ingredient left behind. The background noise of chemicals in homeopathic water is orders of magnitude greater than the signal of whatever had previously been diluted in it.
I must admit, it is possible that our fearless leader Steve has a more robust constitution than I do. I say this because he actually managed to sit through an entire video full of the most bizarre pseudoscience and mangling of physics and medicine that I’ve seen in quite some time.
And that’s saying a lot.
So, behold, Dr. Charlene Werner, an optometrist (apparently) and a homeopath. I warn you, however. If you have any understanding of physics or chemistry whatsoever or if you’ve ever read (and liked) Stephen Hawking’s book A Brief History of Time (or anything else he’s ever written), sit down now. Take a deep breath. Heck, crack open a bottle of wine and down at least half of it before you watch this video. I’m serious. You’ll need it. You might need to lie down, too. In fact, you might need to lie down with a cool washcloth across your eyes.
Don’t say I didn’t warn you:
Truly, the woo doth flow. Like a river. Like the energy from a supernova. From Bozeman, Montana, where, apparently they don’t have enough woo and have to import it from Texas. I haven’t seen such a massive pseudoscientific abuse of physics and chemistry in quite a long time.
Charlene Werner is getting a lot of attention she probably did not anticipate or desire. She is the star of a YouTube video in which she explains the scientific basis of homeopathy. Before you watch it, make sure you are sitting down, relax, and brace yourself for an onslaught of profound scientific illiteracy combined with stunning arrogance. For those with more delicate constitutions I will give you the quick summary:
Einstein taught us that energy equals matter and light, but because matter can be condensed down to a very small space if you remove all the empty space between the elementary particles (I am paraphrasing to make her statements minimally coherent), we can mostly ignore matter. Therefore energy is light, and we are all made of energy – not matter (or at least so little matter, you can ignore it). Stephen Hawking then came up with string theory, which tells us that all matter (which we can ignore) is made of vibrating strings. Therefore we are made of vibrating energy. All diseases are therefore caused by unhealthy vibrational states, and all disease can be treated by returning the body to a previous healthy vibrational state. This can be done with homeopathy, which extracts the vibrational energy out of stuff and places it in a small pill that can be used at any time.
Got it? This is now my favorite example of meaningless pseudobabble from a CAM proponent. Also, I am not picking on some unrepresentative crank – this is as good as homeopathy gets. Werner may be more clumsy and fumbling than more eloquent homeopathy proponents, but when you strip it down, magical vibrations is what you get. But Werner does a fabulous job of exposing the gaping holes is homeopathic nonsense.
A recent study is being cited as support for homeopathy. For instance, the Homeopathy World Community website says
Luc Montagnier Foundation Proves Homeopathy Works.
Dana Ullman cites it in the comments to this blog
And I assume that you all have seen the new research by Nobel Prize-winning virologist Luc Montagnier that provides significant support to homeopathy.
Nope. Sorry, guys. It doesn’t. In fact, its findings are inconsistent with homeopathic theory.
The study has nothing whatsoever to say about homeopathy. Its abstract concludes:
This opens the way to the development of highly sensitive detection system for chronic bacterial infections in human and animal diseases.
Homeopaths are grasping at straws when they cite this study. It involved dilution and agitation: that’s the only possible hint of anything homeopathic and it is nothing but a false analogy. (more…)
As many of our readers know, there are plenty of websites devoted entirely to fake medicine. Sites such as whale.to and NatrualNews are repositories of paranoid, unscientific thinking and promotion of dangerous health practices. Thankfully, they are rather fringe (but not fringe enough). More mainstream outlets print some pretty bad stuff, but it’s usually just lazy reporting and not a concerted, organized effort to promote implausible medical claims. As many of us have written, both hear and at our other blogs, the Huffington Post is the exception. It actively and in an organized way promotes dangerous, implausible pseudo-medicine. This starts at the top with Arianna, and is actively encouraged by medical and health editors like Patricia Fitzgerald and Dean Ornish. In the spring, our complaints were picked up briefly by the larger blogosphere and for a while, HuffPo appeared to have toned it down. Some of that may have been due to our critique of their flu coverage, much of which was mere infomercials for patent medicine.
As the old joke goes, “Break’s over—back on your knees.” HuffPo has jumped back into the quakery pond with full abandon. Venues like HuffPo are one of the reasons a site like this one are necessary. So let’s take a look at the latest abominations from “the other side”.