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“Acupuncture Anesthesia”: A Proclamation from Chairman Mao (Part II)

An Anesthesiologist’s Perspective

The late John Bonica (1917-1994), one of the great anesthesiologists of the 20th century, has been called “The Founding Father of the Pain Field.” He developed this interest while treating wounded soldiers at Fort Lewis, Washington, during WW II. Shortly thereafter he became a pioneer of epidural analgesia and other forms of safe pain relief for labor and delivery. In 1947 he created the first multidisciplinary pain clinic, at Tacoma General Hospital, and in 1960 brought it to the University of Washington School of Medicine when he became the founder and first chairman of its Department of Anesthesiology. In 1953 he published the first comprehensive textbook on the subject of pain, the 1500 page Management of Pain. In 1973 he founded what is now the largest professional organization devoted to pain relief, the International Association for the Study of Pain (IASP).

Dr. Bonica was born in Italy. He came to New York City with his family when he was 11. His father died four years later and he became the major breadwinner for the family. He competed in wrestling while in high school and won both the New York City and state championships. Later he worked his way through college and medical school by wrestling professionally under the pseudonym ‘Johnny (Bull) Walker’, and according to several sources he was the “Light Heavyweight Wrestling Champion of the World.” He continued to wrestle while in the army but concealed his military identity by becoming, in the ring, the “Masked Marvel.”

At the time of the burgeoning Western interest in acupuncture in the early 1970s, Dr. Bonica became the Chairman of the Ad Hoc Committee on Acupuncture of the National Institutes of Health (NIH). In 1973 he was “selected by the Committee on Scholarly Communication with the People’s Republic of China of the National Academy of Sciences to be a member of the first official American medical delegation to visit the People’s Republic of China, and was given the responsibility of evaluating acupuncture and anesthesia as practiced in that country.”

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Posted in: Acupuncture, Medical Academia, Politics and Regulation, Science and the Media

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“Acupuncture Anesthesia”: A Proclamation from Chairman Mao (Part I)

James Reston’s Appendectomy

For many Americans, the current wave of public fascination with “complementary and alternative medicine (CAM)” can be traced to a single event: New York Times columnist James Reston’s appendectomy in China during the summer of 1971, which Reston reported in an interesting and amusing article on July 26 of that year. Many of those who noticed the publicity following this event erroneously concluded that Mr. Reston had undergone “acupuncture anesthesia.” A few years ago, a Google search for “acupuncture and Reston” revealed that approximately 50% of the numerous “hits” reported this, as though it were an uncontroversial fact. Other sources have suggested the same, but in veiled language. Here are examples of each: 

In the 1970s, interest in the procedure was sparked when New York Times editor James Reston wrote an article about his experience with acupuncture. Reston was covering Richard Nixon’s visit to China when Reston needed an emergency appendectomy, and acupuncture was used as an anesthetic.—UPenn News 1995 

In 1972 President Nixon opened the doors to China. A New York Times journalist James Reston was in China at the time and had an emergency appendectomy with acupuncture used as the anesthetic.—American Acupuncture 

[Acupuncture] made its official appearance in the U.S. in 1971 when an article by J. Reston was published in the New York Times describing his personal experience with acupuncture. While in Beijing reporting on a Ping-Pong tournament, he underwent an emergency appendectomy. Acupuncture was used as surgical anesthesia and to relieve post-operative pain. —Center for the Healing Arts, P.C.

The first US national media coverage concerning Acupuncture was in 1971 during President Nixon’s visit to China. There, visiting columnist James Reston told of his emergency appendectomy performed under Acupuncture anesthesia.— AZ Multicare

When New York Times columnist James Reston underwent an appendectomy while accompanying the Nixon entourage to Beijing in 1971, he wrote about a medical discovery called “acupuncture anesthesia.” Eisenberg, David, with Thomas Lee Wright: Encounters with Qi (p. 28) 

About a month after his appendectomy, Reston did write about acupuncture anesthesia—but not referring to his own operation.

Those who don’t report that Reston had acupuncture anesthesia are likely to write, also erroneously, that his “intense post-operative pain was relieved by acupuncture”:

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Posted in: Acupuncture, Medical Academia, Science and the Media, Surgical Procedures

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Homeocracy 3

The previous post of this series analyzed the results of the 1994 Pediatrics paper purporting to show a statistically significant effect of homeopathic preparations on acute childhood diarrhea in a population in Nicaragua. That clinical trial followed a pilot study that also had shown a small but statistically significant effect of homeopathic remedies.

A moment here for explanation as to why I am going through these old studies. Reports like the four or five in this series made headlines. They are also so well cloaked in manipulated data and overdrawn conclusions that press and even academicians accept their conclusions – and even overdraw more. This is still going on.

Over the past thirty years some of us informally and gradually developed semi-systematic ways of analyzing these increasingly scientific-appearing claims of sectarians (sCAMmers.) Errors, inconsistencies and falsifications we recognize now were not so obvious decades ago. SCAMmers developed imaginatively new methods as their fields progressed. We in the science-based or knowledge based medicine field have been trailing along, detecting their tricks and twists as they developed, and like street sweepers behind horses, picking up their excrement (metaphor to force attention.)  Yesterday’s lucid post on the latest acupuncture study by Steve Novella exemplifies this expertise (no offense intended.)
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Posted in: Clinical Trials, Homeopathy, Medical Academia, Science and Medicine

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Harvard Medical School: Veritas for Sale (Part VI)

Loose Ends: Dr. Koh and More

After Dr. Federman’s letter and my reply, posted in Part V of this series,† there seemed little point in pursuing the matter further. Although Dr. Federman never answered my reply, he did send, at my request, a copy of Commissioner of Public Health Howard Koh‘s written “construction of the events in the Massachusetts Special Commission.” As you may recall, those events had occurred at meetings that Dr. Koh never attended:

July 29, 2002

Dear Dr. Federman:

I have had an opportunity to review Dr. Kimball Atwood’s characterizations of the role Dr. David Eisenberg played as an advisor and designee of the Department of Public Health (DPH) and I am writing to clarify several misrepresentations of that role. As you may know, I personally selected Dr. Eisenberg as my designee for the Massachusetts Special Commission on Complementary and Alternative Medical Practitioners based on his high level of scientific and clinical expertise in the field, as well as his international reputation for evidence-based research. I felt at that time, as I do now, that he was the appropriate choice to represent the Department and I am extremely grateful for his advice and his integrity during this most contentious process.

During the course of the Commission, Dr. Eisenberg brought to my attention some of the conflicts that had arisen among the members, despite his attempts to diffuse the hostility and to engage the members in collegial debate. In an effort to overcome these difficulties and deflect unwarranted criticism, Nancy Ridley, Assistant Commissioner for Health Quality Management, attended the meetings over the last six months as the DPH voting designee, with Dr. Eisenberg as an advisor. She also organized a DPH workgroup of the Commission in an attempt to bring consensus and closure to what had become a very polarized and highly personalized process.

I need to state emphatically that the approval of the final Commission report is my responsibility, and is largely a product of the DPH workgroup that Assistant Commissioner Ridley chaired. Dr. Eisenberg had actually not been supportive of either the “majority” or “minority” reports that were originally presented, and neither was Ms. Ridley. She attempted to address as many of Dr. Eisenberg’s concerns as possible but knew he still had issues with the final document. She feels very strongly that there needs to be regulatory oversight of non-physician practitioners of complementary and alternative naturopathic practice. Assistant Commissioner Ridley, on behalf of the Department and with my consent, signed the report that included a significant number of revisions which narrowed the scope of practice, ensured collaborative relationships between physician and non-physician practitioners, and broadened the scope of any proposed regulatory oversight required. Dr. Eisenberg’s advice to DPH was delivered in a fair and balanced manner based his outstanding experience as a clinician and scientist.

I believe that one of the contributing factors for the polarization within the Commission had little to do with Dr. Eisenberg’s participation rather than that of his staffperson, Michael Cohen, who attended Commission meetings in his absence. Mr. Cohen was repeatedly characterized as the alternate DPH designee, which he was not.

In summary, Dr. Eisenberg’s expertise and professionalism throughout this difficult process have been greatly appreciated by the Department. DPH was truly fortunate to be represented and advised by a person of Dr. Eisenberg’s stature and character. I would be more that pleased to speak to you or Dean Martin on his behalf. Please feel free to contact me at xxx.xxx.xxxx if you need any additional information.

Sincerely,

Howard K. Koh, MD, MPH

The range of self-serving misrepresentations in that letter is wide, and is worrisome in someone who will be “responsible for the major health agencies, including the CDC, FDA and NIH, and [will be] the leading health advisor to the Secretary of HHS.” I have already discussed some of the facts here and here, and will add more now.

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

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Harvard Medical School: Veritas for Sale (Part V)

September 26, 2002

Kimball Atwood, M.D.
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Dear Kim,

I have now had time to look into the allegations in your letter of June 14th which, incidentally, I shared with Dr. David Eisenberg and he with several others. I have sought consultation about our exchanges and the gist of my response follows.

Some of your concerns and allegations are very helpful and constructive. Perceptions are particularly important in controversial fields where there is limited objective proof. Your cautions and interpretations in this area have been very useful to us.

Some of what you said is just plain wrong. This includes the allegation the Harvard has “a stake” in the area and therefore would not look into your allegations objectively. Relatedly, Dr. Howard Koh has written us a construction of the events in the Massachusetts Special Commission that is strikingly different from yours. And Dr. Anthony Komoroff has pointed out that many of your comments about the InteliHealth treatment of CAM are now grossly out of date as the material inherited from another provider has been reviewed by HMS faculty and modified. [Indeed, you have referred in other correspondence to modifications you have noticed.] Dr. Komaroff also commented on the misleading way your citation the treatment of homeopathy was disconnected from the rest of the paragraph.

Some of what you said is a matter of taste or interpretation, where even well intentioned people may disagree. In this particular area I have weighed your arguments carefully and, in places, learned from them.

But I think the biggest difference may be in a misperception about what our purposes are. The Council of Academic Deans of Harvard Medical School approved beginning a Division of Research and Education in Complementary and Alternative Therapies with exactly the focus described. Our goal is to do peer-reviewed basic and clinical research on the claimed, but unproven, efficacies of complementary and alternative approaches to therapeutics. The recent scientific sessions and requests for proposal held by the Division are clear testament to this intent. In addition, in common with the Association of American Medical Colleges and most of the allopathic schools of medicine, we intend to teach our students something about CAM and in particular how to assess its claims rigorously. We do not, repeat NOT, have any intention of making our students CAM practitioners. They have enough to do learning what we have always focused on.

Sincerely,

Daniel D. Federman, M.D.

cc: David M. Eisenberg, M.D.

………………………….

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The Dull-Man Law

Kimball Atwood is obviously trying to throw mud at Harvard and at homeopathy, but when you throw mud, you get dirty…

(Sigh) So little time, so much misinformation. Hence the Dull-Man Law:

In any discussion involving science or medicine, being Dana Ullman loses you the argument immediately…and gets you laughed out of the room.

This will be the last time that I don’t invoke that law, because it is the perfect opportunity to explain why it is such a useful shortcut. The occasion is the current series about my alma mater, Harvard Medical School (HMS), and its regrettable dalliances with quackery.† The series consists mostly of correspondence that occurred between Dean Daniel Federman and me in 2002. Some of it refers to homeopathy.*

Mr. Ullman, a self-styled expert on homeopathy who lacks any medical training, is a darling of the ‘integrative medicine’ movement, as explained here. He has posted several comments objecting to my assertions in the HMS series. Other commenters have skillfully refuted some of his arguments. Some have been left unchallenged, however, and a naive reader might therefore assume that they are valid. They are not, but explaining why takes time and a modest acquaintance with the topic. Other than to clarify the issues for the uninitiated, then, such time would be wasted. Henceforth, let it not be so: From now on, this post can be cited by anyone wanting to avoid the drudgery of refuting Mr. Ullman’s claims. (more…)

Posted in: Health Fraud, Homeopathy, Humor, Medical Academia, Science and Medicine

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Harvard Medical School: Veritas for Sale (Part IV)

HMS Puts the Messenger in its Crosshairs

When, during the fall and winter of 2001-02 I first approached Dean Daniel Federman of the Harvard Medical School (HMS) with evidence that the HMS “CAM” program was promoting pseudomedicine, I gave him some materials that I thought would be adequate to make the case: ‘CAM’ Director David Eisenberg’s dubious funding sources and his failure to disclose them to the Massachusetts Special Commission; the website of the Caregroup/Harvard Medical School Center for Alternative Medicine Research and Education (CAMRE), which urged anonymous websurfers to “consult your local telephone yellow pages” for ‘naturopathic physicians’ and other quacks; the presence on the ultra-PPO American Association for Health Freedom (AAHF) Advisory Board of attorney Michael H. Cohen, the Harvard CAMRE’s “Director of Legal Programs” (at the time, Dr. Federman agreed with me that the mere existence of such a position was curious, if the CAMRE’s purpose was ”research and education”); that Dr. Eisenberg and Atty Cohen had contributed to a report to the Massachusetts State Legislature recommending a formal state imprimatur for the practice of pseudomedicine; and other embarrassing findings. A bit later, in March 2002, I sent him a draft of the essay that I posted in Parts I and II of this series.

That material proved not to be adequate, for on March 20, 2002, Dr. Federman sent me the following letter:

Dear Kim,

I ready to undertake a formal review of the Harvard Medical School’s Division of Research and Education in Complementary and Alternative Medicine, and of its leadership to investigate the charges outlined in your letter of November 4, 2001, subsequent emails, and our meeting of January 22, 2002 in my office. I have read almost all of the voluminous literature you sent me and am writing to ask you to assist our efforts. Specifically, I am asking you to prepare a one to three page summary of the specific portions of the material you sent me that you consider erroneous, duplicitous, misleading, or fraudulent.* I do not feel I should summarize your views. Please be specific and give sources, where you can, in support of your statements.

I am committed to achieving a careful and balanced review of the issues you raise.

Sincerely,

Daniel E. Federman, M.D.

* [These are terms that I had used in my communications with Dr. Federman; the only one from which I backed away, after he reacted with considerable alarm, was "fraudulent."]

That was the first real suggestion that the fix was in. The pertinent literature that I’d sent Dr. Federman did not consist of “my views” or even my words. It consisted of statements copied from CAMRE publications and other public sources. Why did Dr. Federman now seem to be framing the issue as a matter of (my) opinion? Why weren’t the points that I’d already presented and documented (they were specific and I gave sources) sufficient to trigger an independent, formal review? What about the summary that I’d already written in the form of a letter to Harvard Magazine, which Dr. Federman had also read? No matter: I was still confident that he would do the right thing when he saw the totality of the evidence, abundantly and overwhelmingly supporting my contention that the CAMRE and other HMS affiliates were promoting pseudomedicine—dangerously, unethically, and in contrast to their stated purpose.

It was then that I resolved to write the essays that I posted in Parts I, II and III of this series.‡ I also prepared the summary that Dr. Federman had requested, which is reprinted below. In June, 2002, I sent these together with this letter:

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Harvard Medical School: Veritas for Sale (Part III)

In Parts I and II of this series* we saw that from 2000 to 2002, key members of the Harvard Medical School “CAM” program, including the Director, had promoted quackery to the legislature of the Commonwealth of Massachusetts. We also saw other explicit or tacit promotions by Harvard institutions and professors, and embarrassing examples of such promotions on InteliHealth, a consumer health website ostensibly committed to “providing credible information from the most trusted sources, including Harvard Medical School….”

Those points were made in an essay that I sent in the spring of 2002 to Daniel Federman, the Senior Dean for Alumni Relations and Clinical Teaching at Harvard Medical School (HMS). I also sent Dr. Federman a treatise on homeopathy, including several examples of credulous Harvard professors and misrepresentations aimed at students, patients, and the public. Much of the content of that treatise has been covered by the series on homeopathy† with which I began my stint here on SBM, so here I’ll post only the parts relevant to promotions by academic physicians, including those at Harvard. There is a bit of redundancy involving InteliHealth, but please bear with me if you’ve made it this far; the discussion will be meatier than the short summary in Part II.

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Harvard Medical School: Veritas for Sale (Part II)

In Part I of this series† we saw that in 2001 Dr. David Eisenberg, the Director of the Harvard Medical School Center for Alternative Medicine Research and Education (CAMRE), and Atty Michael Cohen, the CAMRE’s Director of Legal Programs, had contributed to a report commissioned by the Commonwealth of Massachusetts that would, if accepted as valid by the legislature, provide state protection for a group of quacks to practice ‘medicine.’ We also saw that Dr. Eisenberg had accepted funds from this very group, without having disclosed that information to the relevant state Commission. We saw examples of the quackery that the group espouses, including methods advocated by Thomas Kruzel, the Chief Medical Officer of the school that had contributed money to Dr. Eisenberg’s Harvard “Complementary and Integrative Medicine” course.

We continue now with the essay that I sent in the spring of 2002 to Dr. Dan Federman, the Senior Dean for Alumni Relations and Clinical Teaching at Harvard Medical School (HMS). As before, I’ve provided hyperlinks to many of the citations that I included in my original essay; some, however, are no longer available.

…………………

The American Association of Health Freedom

Kruzel and Harvard’s Michael Cohen are listed as key figures—Kruzel the Secretary, Mr. Cohen the only lawyer on the Advisory Board—in a lobbying organization known as the American Association of Health Freedom (AAHF). Formerly known as the American Preventive Medical Association (APMA), it was founded by Julian Whitaker, MD, a former orthopedic surgical resident who decided that “natural therapies” offered a more lucrative career path. Its purpose, as suggested by the standard euphemism, is to convince government of the validity of dubious medical claims through political influence rather than science. The AAHF lobbies heavily for the passage of the annually defeated federal “Access to Medical Treatment” act, which would allow quacks to prey freely on unwary consumers.

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Harvard Medical School: Veritas for Sale (Part I)

Several years ago I stumbled upon disturbing information regarding my alma mater, the Harvard Medical School (HMS).† Its professed commitment to investigate implausible medical claims had somehow metamorphosed into the advocacy of such claims. I’ve previously mentioned some of this on SBM (here and here). A couple of pertinent essays appeared in the public domain in 2002 and 2003, but the full story was much more involved than those pieces revealed. In the wake of recent posts on SBM about medical schools exposing students to uncritical portrayals of pseudomedicine, it seems appropriate to tell more of it. I’ve also decided to name names, which is something that I would have been reticent to do a few years ago. The basis for that decision will become clear over the next few posts, I trust. This topic will require at least three posts.

My discovery that HMS had begun promoting pseudoscientific medical claims was occasioned by my experience on the Massachusetts Special Commission on Complementary and Alternative Medical Practitioners, which met from the fall of 2001 to the winter of 2003. Another member of that commission was David Eisenberg, the Director of the Harvard Medical School Center for Alternative Medicine Research and Education (CAMRE) and of the new Osher Center for Complementary and Integrative Medical Therapies. Dr. Eisenberg is best known for his 1993 article reporting the use of ‘unconventional therapies’ by Americans. He had been appointed to the commission by the MA Commissioner of Public Health at the time, Dr. Howard Koh–whom President Obama has recently nominated to be Assistant Secretary of HHS. I assumed then, and still do, that Dr. Koh presumed Dr. Eisenberg to be an objective expert on “CAM,” since that was the persona presented by HMS and by Dr. Eisenberg himself. I had my doubts, but before then I’d not bothered to look into the matter.

It was during commission meetings, when I had the opportunity to hear what Dr. Eisenberg and his surrogate had to say or not to say and when I examined some of their writings and funding sources, that I began to realize how far his project was deviating from what I imagined to be the agenda of HMS. Some of what I saw amounted to frank dishonesty: failure to disclose obvious conflicts of interest to the Commission, for example. I also discovered public promotions of dubious “CAM” practices and practitioners by the CAMRE, in spite of its formal purpose being that of investigating “CAM” practices in an attempt to find out if any might be useful. I was concerned enough to look at other “CAM” information offered in the name of Harvard, and I found more worrisome examples.

I also attended the Feb., 2001 Harvard Complementary and Integrative Medicine Course, directed by Dr. Eisenberg (here is a link to the similar 2002 course brochure). A few of the talks were reasonable, if banal. I did my best to give them the benefit of the doubt, because I still could not accept that HMS would seriously consider homeopathy, ‘life-force,’ and ‘subluxations’ as being worthy of study, much less advocacy. After attending a semi-rigorous talk on raw herbs as medicines (the presenter discussed some studies but not the looming question of why whole herbs might be preferable to purified molecules), I ran into Eisenberg and did my best to be polite and encouraging. I shouldn’t have, because most of the content of the course was misleading and pseudoscientific. Overall, its tone was more like a political rally or a religious revival than a scientific conference.

At that course I ran into Russell Phillips, who had been in my group of interns at the Beth Israel Hospital (Boston) in 1979. I’d seen him around from time to time over the years, and I’d known that he’d stayed on at the BI after his residency. I was surprised, however, to learn that he was now the Director of the Harvard CAMRE Fellowship program. I was even more surprised to learn, during a short conversation with him, that he was innocent of the chiropractic ‘subluxation theory’ and that he’d never heard of Quackwatch. It seemed to me that there was either a surprising naivete among this crowd or an attempt by some to shun unpleasant information.

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