Science-Based Medicine

Make no little plans; they have no power to stir men’s blood.

Politics is deadly to science-based medicine, and while I don’t often go for politics, the last eight years have seen subtle and not-so subtle predations on the practice of medicine. Will the new administration be able to promote the kind of change we need? Let’s review some of the challenges facing the Obama administration.

Ethical apocalypse

Bush’s evisceration of the Constitution of the United States has affected health care professionals. The military has likely always used psychologists to assist with interrogations, but the last eight years has seen a huge increase in the number of secret charges, unconsitutional imprisonment, and “forceful” interrogations. Military psychologists have been put in the position of choosing between what their country demand of them, and what their ethics and responsibilities to other human beings requires…

More…Additionally, the (now former) administration worked tirelessly to push through so-called “conscience clauses” during the waning days of their power. Given the challenges of the Mid-East, the economy, and other crises, it’s hard to imagine why they would think this should be a priority, but apparently giving health care providers legal protection to advance their own needs above those of their patients seemed like a good idea at the time.
Continue Reading »

Much nonsense has been written in the guise of longevity medicine. In Fantastic Voyage, Ray Kurzweil explains why he takes 250 pills every day and spends one day a week at a clinic getting IV vitamins, chelation, and acupuncture. He is convinced this regimen will keep him alive long enough for science to figure out how to keep him alive forever. In Healthy Aging, Andrew Weil chips in with his own mixture of science and magic. I pointed out the flaws in their reasoning in a review for Skeptic magazine – available online. There are many other popular books that promise to tell you how to live longer. Most of them amount to little more than speculation based on extrapolations from animal studies, in vitro studies, and odd non-clinical facts.

There simply is no evidence that any intervention will extend the human life span. The most promising idea from animal studies, severe calorie restriction, is not practical or palatable and would make adequate nutrition difficult. We don’t know how to prolong human life to, say, 130 years; but we do know how to prevent a number of diseases from causing premature demise at 60 or 70. That’s what real “longevity medicine” means.

To counteract all the belief-based and speculation-based “longevity medicine,” we needed a science-based longevity book. And now we have it. Carl Bartecchi, MD and Robert W. Schrier, MD have written a book entitled Living Healthier and Longer – What Works, What Doesn’t. The price is right – it is available online for free download. Continue Reading »

“When I use a word,” Humpty Dumpty said in rather a scornful tone, “it means just what I choose it to mean — neither more nor less.”

“The question is,” said Alice, “whether you can make words mean so many different things.”

“The question is,” said Humpty Dumpty, “which is to be master— that’s all.”

From: Through the Looking Glass, and
What Alice Found There by Lewis Carroll

“How can I help seeing what is in front of my eyes? Two and two are four.”

“Sometimes, Winston. Sometimes they are five. Sometimes they are three. Sometimes they are all of them at once. You must try harder. It is not easy to become sane.”

From: Nineteen Eighty-Four by George Orwell

One of the most powerful weapons in the armamentarium of advocates of the unscientific and implausible medical practices that fall under the rubric of “complementary and alternative medicine” (CAM) or, even worse, “integrative medicine” (IM), both of which seek to seamlessly “integrate” pseudoscience with science to the point that people start to be unable to tell which is which in order to “complement” effective medicine with placebo-based medicine, is their skill manupulating language. Wally Sampson has harped on this time and time again on this blog, particularly in his masterful fictional (but all too true-sounding) response to the question, “Why would medical schools associate with quackery?” Kimball Atwood has even turned the–shall we say?–”plasticity” with which CAM/IM advocates manipulate language to their advantage into humorous and all-too-infrequently recurring Friday feature. All of us have complained about how CAM/IM advocates have coopted diet and exercise as being somehow “alternative” and are now using that as the “foot in the door” to introduce pseudoscientific quackery like reiki and homeopathy into not just medical schools but to try to persuade the incoming Obama Administration to fund quackery on equal terms with scientific medicine as part of a “reform” designed to “promote health.”

Much of the success, both previous and current, of CAM/IM advocates depends upon language. Just like Humpty-Dumpty, to ideologues like Deepak Chopra, words mean just what they choose them to mean, and, just like the view forced on Winston Smith at the Ministry of Love, two plus two are sometimes five, no matter how much we know they are four. All it takes is viewing science as “just another narrative,” as postmodernist supporters of CAM/IM would like. Once that happens, there is nothing to stop one from viewing CAM/IM as being a “narrative” just as valid as that of science-based medicine. It’s the way “quackery” has been transformed into “unconventional,” later into “alternative,” and most recently “integrative” medicine. It’s all designed to play on the natural American desire to be “fair” and the media’s desire for “balance,” even though it is not fair to give pseudoscience a patina of scientific respectability that it does not deserve or use “balance” to present quackery as though it has equal standing with scientific medicine.

If there is one word that has been corrupted by the CAM/IM movement more than any other, my vote would go the world “natural.” Of course, it’s not just the CAM/IM movement that has molded this word to mean whatever meaning is required for whatever purpose is desired. For decades, the advertising industry has done the same. However, the CAM/IM movement takes it to a new level, or “kicks it up a notch,” as a certain TV chef likes to say.

I came across a perfect example of this in the form of a man named Tony Isaacs.
Continue Reading »

The following book review was written not by your poster (although I’ve added the hyperlinks), but by his friend Cees Renckens, who is a gynecologist in the Netherlands and the chairman of the Dutch Society against Quackery. A short bio of Dr. Renckens, including references to several articles in English, follows the review. Most impressive to me is that he is, as far as I know, the first and only person in the world to have earned a PhD in a field that describes much of the content here at Science-Based Medicine: the rational evaluation of anomalous and implausible medical practices.

For several years, Dr. Renckens and the Dutch Society have been embroiled in a disturbing legal case involving freedom of speech. This was previously mentioned on SBM by astute reader Dr. Peter Moran. According to Dr. Renckens, the Dutch Supreme Court will issue its final judgment of the case at the end of February.

–KA

…

Complementary and Alternative Medicine: Ethics, the Patient, and the Physician. Edited by Lois Snyder, 241 pp, $69.50, Totowa NJ, Humana Press (2007). ISBN 58829-584-2. 

Reviewed by Cees N. M. Renckens, MD, PhD

During the second half of the 20th century, the Moerman anti-cancer diet was very popular in the Netherlands. Moerman was a family physician with no training in oncology or nutrition. He kept carrier pigeons and believed that his birds never got cancer. Therefore he developed a diet based on food for carrier pigeons. He had no contact with oncologists, nutritionists or other physicians. The Inspector for Public Health for his area was of the opinion that Moerman had “serious medical-ethic defects.”

Add to this example the fact that “alternative” physicians appear to be successful in presenting their approach as highly ethical, with its respect for old wisdom, for the ideas and peculiarities of their patients, and for treatments borrowed from Ayurvedic, Chinese, Tibetan and other third world medical systems, all of which can be classified as backwards, and you can understand why my interest was immediately aroused when I learned that a book had been issued with the title Complementary and Alternative Medicine. Ethics, the Patient and the Physician.

Finally, I thought, a look through ethical glasses at the deceit, at the admissibility of shoddy scientific research of “alternative” treatments, and perhaps a discussion of the necessary rigor of academic medicine and about how to deal with those who reject such rigor. When, in a short review in the Mayo Clinic Proceedings, the book was judged to be “excellent,” I dispelled my dislike of the rather high price and ordered it. 

Continue Reading »

As you may or may not know, Change.gov is being used by Obama’s team to solicit policy ideas. Americans submit ideas, along with supporting rationale, and people “vote up” or vote down” the proposals. “Up” votes increase the score of the proposals, and “down” votes decrease the score. It is described thusly on the Change.gov website:

Share your ideas on any issue facing the new administration, then rate or comment on other ideas. The best rated ideas will rise to the top — and be gathered into a Citizen’s Briefing Book to be delivered to President Obama after he is sworn in.

A couple of days ago, P.Z. Myers let me know about an excellent proposal over at the Citizen’s Briefing Book: Defund the National Center for Complementary and Alternative Medicine:

Here’s a way to increase the available funding to NIH without increasing the NIH budget: halt funding to NCCAM, the National Center for Complementary and Alternative Medicine. This Center was created not by scientists, who never thought it was a good idea, but by Congress, and specifically by just two Congressmen in the 1990′s who believed in particular “alternative” (but scientifically dubious) treatments. Defunding NCCAM would save at least $225 million, possibly more.

Defunding NCCAM would also provide a direct societal benefit. Practitioners of so-called “alternative” medicines constantly refer to NIH’s support as a way of validating their practices and beliefs, most of which are not supported by evidence. The fact is that after >10 years, NCCAM has not yet found a single piece of positive evidence for any of these methods, which include acupuncture, “qi”, homoepathy, magnet therapy, and other treatments.

Any legitimate, promising medical treatment can be funded by one of the existing NIH Institutes. There’s no need for a separate center for “alternative” therapies – but what has happened is that NCCAM has become a last refuge for poorly designed, unscientific studies that couldn’t get funded through the normal peer-reviewed process.

He even cited our co-blogger’s (in)famous article Why the National Center for Complementary and Alternative Medicine (NCCAM) Should Be Defunded. Maybe he should take a gander at my post The National Center for Complementary and Alternative Medicine (NCCAM): Your tax dollars hard at work, as well.
Continue Reading »

The Wall Street Journal has an assessment of Probiotics in the Jan 13, 2009 issue entitled Bug Crazy: Assessing the Benefits of Probiotics (1). For some reason when I wander around the hospital on rounds people show me articles such as this and ask, so whatcha think about this?

Probiotics are interesting. They are live bacteria given to treat and prevent diseases. It is one of those overlap areas for scientific medicine and so called alternative medicine. There are good clinical trials to suggest areas where these agents are of benefit, but other aspects of their use are blown out of proportion for the real or imagined benefit probiotics may provide. Much of alternative medicine where it overlaps with real medicine is the art of making therapeutic mountains out of clinical molehills.

The Wall Street Journal article is the kind of reporting that drives. me. nuts. It drive me nuts because the reporting acts as if the underlying assumptions of the therapies are true.

Continue Reading »

I recently watched a special news report about John McCain leading the charge towards making legislative earmarks illegal. The Economist defines earmarks this way:

Earmarks, for the uninitiated, are spending projects that are directly requested by individual members of Congress and are not subject to competitive bidding.

Most Americans are rightly upset about the practice of slipping pet projects into larger, well-vetted, and consensus-built legislative initiatives. They know instinctively that it’s morally wrong to sneak in personal favors and appropriate tax payer dollars to special interest groups without allowing others to weigh in. I certainly hope that McCain and his peers will succeed in discontinuing this corrupt practice.

Coincidentally, just after I watched this news report about earmarks, I went online to catch up on my blog reading. The first post I encountered made reference to an opinion piece written by Deepak Chopra, Andrew Weil, Dean Ornish, and Rustum Roy in the Wall Street Journal. Chopra et al. were asking Americans to redouble their efforts to adopt healthy lifestyles (including wholesome diets and regular physical activity) as a means to promote good health and avoid disease. At the end of the article they slipped in a plea for President-elect Obama to consider integrating alternative medicine practices (which included everything from healthy diet to meditation and acupuncture) into a government-sponsored approach to health.
Continue Reading »

It is without controversy that the number of autism diagnoses being made is on the rise. In 1991 there were about 6 cases per 10,000 births, and in 2001 there were about 42. This number continues to rise at about the same rate.

The cause of this rise, however, is very controversial. There are basically two schools of thought: 1 – that true autism rates are on the rise, and 2 – that the measured rise is an artifact of increased surveillance and a broadening of the definition. I wrote previously about this very controversy, in which I concluded that the expanded diagnosis hypothesis is much better supported by the evidence.

Now, a new study published last week in the journal Epidemiology is being presented by proponents of the epidemic hypothesis as support for their view. A closer look, however, reveals that this study does not support the epidemic hypothesis and adds little to the overall literature on this question.
Continue Reading »

I recently read Flock of Dodos (no relation to the movie of the same name). It’s a hilarious no-holds-barred send-up of the lies and poor reasoning of the intelligent design movement. I was particularly struck by a quotation from William Dembski’s Intelligent Design.

We are dealing here with something more than a straightforward determination of scientific facts or confirmation of scientific theories. Rather we are dealing with competing world-views and incompatible metaphysical systems.

That cuts to the essence of what we are confronting on Science-Based Medicine. We are trying to evaluate the science behind claims that are often not based on science but on beliefs that are incompatible with science. The claimants are happy to use science when it supports them, but when it doesn’t they are likely to unfairly critique the science or even to dismiss the entire scientific enterprise as a “materialistic world view” or “closed-minded.” We are talking at cross purposes. How can we communicate if we say “this variety of apple is red” and they insist “it feels green to me”?

We get frustrated when we show these folks the scientific evidence and they refuse to accept it. Homeopathy is not only implausible, but it has been tested and has failed the tests. Yet proponents refuse to acknowledge those failures and still want to talk about data from the 19th century and make claims for the memory of water. We have to realize we are not even speaking the same language. We are trying to play a civilized game of gin rummy and they are dribbling a basketball all over the card table. Before getting into a debate, doesn’t it make sense to define what game you’re playing and what the rules are?

Science has been a very successful self-correcting group endeavor. It wouldn’t be successful if it didn’t follow a strict set of rules designed to avoid errors. [Note: there are no rules written in stone; I’m talking about conventions that are generally understood and accepted by scientists, conventions that grow naturally out of reason and critical thinking.] If proponents of alternative medicine want to play the science game, they ought to play by the rules. If they won’t play by the rules, they effectively take themselves out of the scientific arena and into the metaphysical arena. In that case, it is useless for us to talk to them about science.
Continue Reading »

The quest of advocates of unscientific medicine, the so-called “complementary and alternative medicine” (CAM) movement is to convince policy makers, patients, and physicians that it does not deserve the rubric of “alternative,” that it is in fact mainstream. Indeed, that is the very reason why “alternative” medicine morphed into CAM in order to soften the “alternative” label. Increasingly, however, advocates of such highly implausible medical practices appear no longer to like CAM as term for their dubious practicies, because it still uses the word “alternative.” That is, of course, because they recognize that labeling something as “alternative” in relationship to scientific medicine automatically implies inferiority, and CAM advocates are nothing if not full of hubris. Such a term conflicts with their desire to “go mainstream,” and they most definitely do want to go mainstream, but they want to do it on their own terms, without all that pesky mucking about with science, evidence, and rigorous clinical trials. Consequently, they increasingly use a new term, a shiny term, a term free of that pesky “alternative” label. Now they want to “integrate” their unscientific placebo-based practice with real, scientific medicine. Thus was born the term “integrative” medicine (IM, an abbreviation that is the same as that for internal medicine, an identity that I don’t consider coincidence).

One of the biggest complaints we at SBM (or at least I at SBM) have about the attitude of practitioners of scientific medicine towards CAM/IM is that most of them do not see it as a major problem. Dr. Jones characterized this attitude as the “shruggie” attitude, and it’s a perfect term. Equally perfect is her analogy as to why “integrating” pseudoscience with medical science is not a good idea. I myself have lamented the infiltration of pseudoscience and outright quackery into medical academia and the role that the National Center for Complementary and Alternative Medicine (NCCAM) has played in promoting that infiltration. In addition, wealthy patrons of CAM/IM such as Donna Karan and the Bravewell Collaborative have been generous spreading their money around. In this increasingly cash-strapped health care environment, hospitals know on which side their bread is buttered and see the “integration” of woo into their service portfolio as a means of beefing up the bottom line with cash on the barrelhead transactions that require no mucking about with nasty insurance forms. In fact, services such as reiki, homeopathy, acupuncture, and others often require no forms other than credit card receipts for the patient to sign.
Continue Reading »