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The TACT is at least as Bad as We Predicted

I had wanted to follow Dr. Sampson’s discussion of “Healing Touch” with one of my own, because I had an interesting experience with one of its proponents years ago, and I’ll do that soon. I had also wanted to begin a series of posts about acupuncture, which I’ll also do eventually. Just yesterday, however, Liz Woeckner, co-author of our recently published critique of the NIH Trial to Assess Chelation Therapy (TACT), made a startling discovery: the TACT “Portal” website, intended for investigators and others associated with the trial and previously password protected, is now available to anyone: http://www.chelationwatch.org/s/tact/index.html It is a goldmine of information and I’ve barely begun to look at it, but so far it verifies much of what we’ve written and more. For example, the latest version of the Consent Form is dated 2006 and includes this statement under “risks”:

EDTA, or ethylenediamine tetraacetate is in the chelation solution. It is approved for use by the FDA as a treatment for lead poisoning but not for coronary artery disease.

Yet three Investigator Brochures, dating back to 2003, contain this language:

Edetate disodium USP should not be confused with its calcium salt (calcium edetate), which is used to treat lead toxicity.

We had called attention, in our article, to TACT literature repeatedly conflating Na2EDTA and the safer CaNaEDTA. Now we have reason to believe that this has been done cynically, with eyes wide open.

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Posted in: Clinical Trials, Medical Ethics, Politics and Regulation, Science and Medicine

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Christiane Northrup, MD: Science Tainted with Strange Beliefs

After her daughter left for college, Christiane Northrup, MD, went for a morning walk one day. About halfway through her walk she developed an ache in her throat radiating up into her jaw. It felt like a fist was squeezing her esophagus. It persisted even after she returned home. What would you have done?

I think even the average layperson knows that this sounds like a possible heart attack and would call 911 or head for the nearest ER. Instead, Northrup called a medical intuitive who came over and “took out the Motherpeace tarot cards to try to get some clarity.” Together, they interpreted her “heartache” as resulting from her recent disappointment and grief over her family situation. She had unmet needs and it was “no wonder my heart was forced to speak up.”

This behavior from a scientifically trained MD boggles the mind. Christiane Northrup, MD, is a board certified OB/Gyn who has become something of a guru for American women’s health through a series of books, a newsletter, a website, appearances on Oprah, etc. Her third book, The Wisdom of Menopause, has been updated and revised; a friend told me all her menopausal friends are talking about this book. I read it and was appalled. (more…)

Posted in: Book & movie reviews, Science and Medicine

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A real “Era III Emergency Room”

Due to the holiday, I have not had time to compose the usual lengthy and analytic post that readers have come to know and (hopefully) love. However, Dr. Atwood’s Weekly Waluation of the Weasel Words of Woo #6 so perfectly brought a famous (or infamous) parody back from the depths of my memory that I had to go straight to YouTube and find it. I think our readers will appreciate if they haven’t seen it before. The quote that inspired me to resurrect this gem is:

This new era is composed of a blend of the best of what we know of physical, material-based medicine (”Era I”), mind-body medicine (”Era II”), and the caring, compassion, and consciousness that characterize “Era III.” A compelling example is given in the use of all three levels of caring in the “Era III Emergency Room.”He vividly shows us a new kind of emergency department in which an auto crash patient is not only stabilized and sutured but has the suggestion of relaxation imagery along with the lidocaine and nylon. Meanwhile, caring healers take a moment to pray and visualize a positive outcome based on the scientific evidence of the effects of nonlocal mind, employing a network of nonlocal healers as they work.

No, this is the real “Era III Emergency Room”:

The sad thing is, I fear that the above video is not too great an exaggeration of the way medicine is going.I will return next Monday (possibly even sooner) with new material.

Posted in: Humor, Science and Medicine

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We Have to Draw the Line Somewhere

Passive acceptance of Alternative Medicine has eroded the quality of medical care in this country. With the DSHEA of 1994 and political correctness, we have lost the reverence afforded to us in times past. Our professional knowledge is called into question as our standards deteriorate. There no longer exists a line separating proven fact from speculation. There is no border separating reality from mythology. Our colleagues treat with antibiotics and homeopathy. With beta-blockers and energy fields. Qi and narcotics.

For many years, it has seemed that I was nearly alone in my skepticism. Anytime I would bring up an alternative medicine topic, (in reality: criticize it) others in my field would have a ho-hum reaction to it. It was politically incorrect to rant about the growth of alternative medicine, the growing use of herbs, and how something should be done about it. We family and internal medicine doctors are a generally easy lot to live with. We accept patients and their faults, and it is hard to suddenly become judgmental when it comes to our colleagues. I had no idea as a resident that there was so much woo in Colorado. Specifically, I had no idea how much there was at my academic institution. This was in the late 80s, early 90s! Oh my, how things have changed, and not for the better.

I was a naïve resident in 1990, when a nurse practitioner at my residency called me about one of my patients. She wanted to help a 20 year old woman stop smoking by… wait for it….Therapeutic Touch. I was post call, and had trusted this NP as she had been with the residency for many years. I said “yes, go ahead,” not knowing what exactly it entailed. When I did have time to look into it, I was appalled. I was guilty by association. The patient never returned to me, and I don’t blame her. She must have thought I believed in magic. It turns out that the School of Nursing at the University of Colorado had to be called out by the Rocky Mountain Skeptics on their aggressive promotion and advocacy of Therapeutic Touch.

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Posted in: Politics and Regulation, Science and Medicine

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Changing the Rules of Evidence

My daughter, Julia, loves to play games and has a bit of a competitive streak. She can make any activity into a game and is adept at making up rules on the spot. When she was younger, like most children, she had a tendency to add to or change the rules on the fly – usually to ensure a favorable outcome for herself. “Oh, Daddy, I forgot to mention that the ball can bounce once and that still counts.”

It was an opportunity for me to gently teach her that in order for rules to work everyone has to know what they are ahead of time and you can’t change them after the fact. Her smile told me that even at five she intuitively knew this already – that changing or making up new rules was not fair. What I was really teaching her was that she wasn’t going to get away with it with me, and by extension that it is socially unacceptable to mess with the rules to suit oneself.

Adults are really no different than children in our basic emotional makeup. We all want to change the rules to suit our own needs. The true difference is that as we mature we become more socially sophisticated; we become more subtle in our manipulations, and we develop the capacity to rationalize our wants and desires. We also learn that we are playing a bigger game – the social game. So we adhere to the rules of fairness, even if it means losing a competition, because we want to succeed at the more important game of socialization. (I’m not making any moral or ethical judgments here, just observing human behavior.)

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Posted in: Clinical Trials, Science and Medicine

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Reading Medical Literature with a Critical Eye

A long time ago I read a study about what makes a good doctor. Some things you might think were important, like grades in medical school, were irrelevant. What correlated the best was the number of medical journals a doctor read. I don’t know whether that means good doctors read more journals or reading more journals makes a better doctor.

One thing I do know is that most of us could learn better journal-reading skills. When I was a busy clinician, I did what I suspect many busy clinicians do: I let the journals pile up for a while, then tackled a stack when I got motivated. I would skim the table of contents to pick out articles that I wanted to read, then I would read the abstracts of those articles. If the abstract interested me, I would read the discussion section of the article. If I was still interested, I might go back and read the entire article. But until after I retired, I never really developed the skills to evaluate the quality of the study.

I knew enough not to jump on the bandwagon the first time something was reported, because I had seen promising treatments bite the dust with further testing. But I really wasn’t aware of all the things that can go wrong in a study, and I didn’t know what to look for to decide if the results were really credible. I’m not an academic; I thought the authors knew a lot more than I did, and I trusted them to a degree that was not warranted. (more…)

Posted in: Pharmaceuticals, Science and Medicine

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The “Art” of Clinical Decision-Making

Much nonsense has been written about the “art” of medicine. All too often, it amounts to a rationalization for doctors doing what they want to do instead of following the evidence. Medicine is not an art like painting. Neither is it a science like physics. It’s an applied science. Since patients are not all identical, it can be very tricky to decide how to apply the science to the individual.

The New England Journal of Medicine periodically runs a feature called “Clinical Decisions.” They present a case history, then they present 2 or 3 expert opinions on how to manage the case. They stress that none of the options can be considered either correct or incorrect. They allow readers to “vote” as well as to submit comments about why they voted that way. It is understood that the voting is only for interest and to stimulate discussion: it does not result in a consensus.

In April 2008 the topic was the management of carotid artery stenosis. The patient is a 67 year old man who has no symptoms but who is found to have a narrowing of 70-80% in one carotid artery and 20% in the other, putting him at increased risk for stroke. He has other risk factors for cardiovascular disease: hyperlipidemia, hypertension, and overweight. The 3 options are medical management, stent placement, and carotid endarterectomy. (more…)

Posted in: Science and Medicine

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The early detection of cancer and improved survival: More complicated than most people think

“Early detection of cancer saves lives.”

How many times have you heard this statement or something resembling it? It’s a common assumption (indeed, a seemingly common sense assumption) that detecting cancer early is always a good thing. Why wouldn’t it always be a good thing, after all? For many cancers, such as breast cancer and colon cancer, there’s little doubt tha early detection at the very least makes the job of treating the cancer easier. Also, the cancer is detected at an earlier stage almost by definition. But does earlier detection save lives? This question, as you might expect, depends upon the tumor, its biology, and the quality and cost of the screening modality used to detect the cancer. Indeed, it turns out that the question of whether early detection saves lives is a much more complicated question to answer than you probably think, a question that even many doctors have trouble with. It’s also a question that can be argued too far in the other direction. In other words, in the same way that boosters of early detection of various cancers may sometimes oversell the benefits of early detection, there is a contingent that takes a somewhat nihilistic view of the value of screening and argues that it doesn’t save lives.

A corrollary of the latter point is that some boosters of so-called “alternative” medicine take the complexity of evaluating the effect of early screening on cancer mortality and the known trend towards diagnosing earlier and earlier stage tumors as saying that our treatments for cancer are mostly worthless and that the only reason we are apparently doing better against cancer is because of early diagnosis of lesions that would never progress. Here is a typical such comment from a frequent commenter whose hyperbolic style will likely be immediately recognizable to regular readers here:

Most cancer goes away, or never progresses, even with NO medical treatment. Most people who get cancer never know it. At least in the past, before early diagnosis they never knew it.

Now many people are diagnosed and treated, and they never get sick or die from cancer. But this would have also been the case if they were never diagnosed or treated.

Maybe early diagnosis and treatment do save the lives of a small percentage of all who are treated. Maybe not. We don’t know.

As is so often the case with such simplistic black and white statements, there is a grain of truth buried under the absolutist statement but it’s buried so deep that it’s well-nigh unrecognizable. Because we see this sort of statement frequently, I thought it would be worthwhile to discuss some of the issues that make the reduction of mortality from cancer so difficult to achieve through screening. I will do this in two parts, although the next part may not necessarily appear next week
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Posted in: Cancer, Public Health, Science and Medicine, Science and the Media

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“CAL”: a Medico-Legal Parable

Preamble

From the fall of 2000 to the winter of 2002, the Commonwealth of Massachusetts convened a Special Commission on Complementary and Alternative Medical Practitioners. There were 12 members: 6 legislators, 3 MDs, a naturopath, a lawyer who represented the New England School of Acupuncture, and the chairman, who was also the Director of the Massachusetts Division of Professional Licensure. At the start of deliberations two things became apparent: first, the Commission would concern itself almost exclusively with the petition of “naturopathic physicians” to become licensed health care practitioners in the Commonwealth*; second, there were only two recognizable, medically-sophisticated skeptics among the members. They were Arnold “Bud” Relman, the emeritus editor of the New England Journal of Medicine (appointed by the Massachusetts Board of Registration in Medicine), and I (appointed by the Mass. Medical Society). We expected a third, an MD soon to be appointed by the Commissioner of Public Health, Dr. Howard Koh.

Within a few weeks it became clear that the third MD would not be a skeptic. Dr. Koh, apparently thinking he had found an expert, appointed as his representative David Eisenberg, Director of the Harvard Medical School (HMS) Division for Research and Education in Complementary and Integrative Medical Therapies. Dr. Koh must not have known that in 1997 Dr. Eisenberg had called for

A national listing of licensed alternative medical providers (e.g., chiropractors, acupuncturists, massage therapists, naturopaths, and homeopaths) in each of the 50 states as well as a uniform credentialing process.

Commissioner Koh also must not have known that Dr. Eisenberg had received or was currently receiving funds from several sources committed to furthering the ambitions of ”CAM” practitioners in general or of “naturopathic physicians” in particular: the NCCAM, the Fetzer Institute, the New York Chiropractic College, Cambridge Muscular Therapy Institute, New England School of Acupuncture, American Specialty Health Plan, and the Southwest College of Naturopathic Medicine.

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Posted in: Politics and Regulation, Science and Medicine

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The Weekly Waluation of the Weasel Words of Woo #5

The Master Speaks

It was a delightful surprise for me, and I hope for you fans of the W^5/2, to log onto SBM on Thursday and find this blog by Dr. Wallace Sampson. As I mentioned in that long-ago posting that introduced the topic that eventually hatched the W^5/2, Dr. Sampson is my Yoda, when it comes to the topic that he named: Language Distortions. More about that below.

When the Goin’ Gets Tough…

OK, I’ll admit I threw you a curveball last time. That shaman thing rilly was a bit over the top, even if it rilly did come from an honest-to-god Sacred ”CAM” Scroll. Reminds me of something by Jonathan Swift…I can’t remember where…Gulliver, maybe?…he copied, verbatim, a ship captain’s log, recognizing it as a good satire by itself (extra credit for any reader who finds that reference). So I rilly can’t blame Stu (m’man!) and homeboy David Gorski for their reluctance to Waluate that Suckah. Stu, true to expectations, even submitted an additional explanation that was pretty frickin’ funny in its own right.

The Tough Get Goin’!

On the other hand, five readers Dug Down Deep to Deconstruct the Dang Deal, and they deserve full credit! The winner was, without question, Michelle B: she submitted the most comprehensive translation, even providing a comparative look at ancient and modern popular culture. Michelle B, for the W^5/2 #4, You Da Woman.

Second place goes to mmarsh, a newcomer to the W^5/2, who looks like a playah. Here’s hoping he/she becomes a regular.

Honorable mentions for DVMKurmes , Michael X (in an elliptical sort of way), and overshoot, each of whom gave it a shot, if, er, a somewhat abbreviated one. I wasn’t sure whether wertys was offering a formal Waluation or just an amusing observation, but either one is always welcome, of course. Same for the observation of reechard. Keep those cards and letters comin’!

This Week’s Entry

In honor of Dr. Sampson’s recent blog, here’s another snippet from the article whose abstract he translated:

The integrative medicine movement is fueled not only by the dissatisfaction of consumers with conventional medicine, but also by the growing discontent of physicians with changes in their profession. Physicians simply do not have the time to be what patients want them to be: open-minded, knowledgeable teachers and caregivers who can hear and understand their needs. Their unhappiness is not just the result of the limitations managed care has placed on their earning capacity. It is also a response to a loss of autonomy, to a loss of fulfilling relationships with patients, and, for some, to a sense that they are not truly helping people lead healthier lives. Significant numbers of physicians are now quitting medical practice, and applications to medical schools are decreasing precipitously.

As I’m sure you’ll already have noticed, the “plot” of that paragraph has a little something that’s different from the usual fare.

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: Humor, Medical Academia, Science and Medicine

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