Sep 28 2009
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”.
First off, Dana Ullman—they really did it this time. They’ve taken the guy I think of as “Hahnemann’s cognitively impaired bulldog” and given him a regular spot over there. Ullman is a major booster of homeopathy, as readers of this blog may remember.
His inaugural piece, entitled The Wisdom of Symptoms: Respecting the Body’s Intelligence betrays a stunning level of ignorance of basic human biology.
I have good and bad news about the human body: it is neither wise nor foolish, good nor evil, nor is it simple in any way. It is a complex system where few simplistic explanations suffice. It would be nice to believe in “feed a cold, starve a fever” and other simplistic pablum, but things are rarely so simple. This is why there is a science to medicine—our instincts and hunches often betray us, and only by studying the body systematically can we form valid conclusions.
Or, if you’re lazy or deceitful, you can just make it up as you go along.
Which brings us to Dana Ullman who has come up with the shattering observation that, “just because a drug is effective in getting rid of a symptom does not necessarily mean that this treatment is truly curative (or even helpful).”
Really? I never would have guessed that—which is why I read the literature, which is pretty damned clear that sweeping generalizations such as this are meaningless. Take the symptom of chest pain—if you don’t know the likely causes of a case of chest pain, you won’t know how to work it up or treat it properly. Giving someone nitroglycerin may make a patient feel better, but may indicate a cardiac etiology or an esophageal etiology. If you simply treat the pain with nitroglycerin without treating the underlying cause you may cause someone to die. That would be a bad thing. His “revelation” simply reveals how ignorant he is about current concepts of human medicine.
His ignorance, rather than giving him pause, leads to more senseless expostulations. He goes on to write about the “wisdom” of the body, whatever that means.
Our human body has survived these thousands of years because of its incredible adaptive capabilities, and one of the ways that it adapts is through the creation of symptoms. Whether it be through fever and inflammation, cough and expectoration, nausea and vomiting, fainting and comatose states, and even the variety of emotional and mental states, each symptom represents the best efforts of the bodymind to fight infection and/or adapt to physical and psychological stresses.
What an ignorant load of goat droppings. First of all, “the human body” has not “survived these thousands of years”. As a distinct species we are a couple of million years old, more or less. We have survived because we have survived. If we hadn’t survived, we wouldn’t be having this discussion. Human beings have been generally able to reproduce at a faster rate than we die. Our bodies work very much like other mammals (and other vertebrates for that matter). While vomiting may be “beneficial” when it is caused by a toxic ingestion, it is not so beneficial when it is caused by increased intracranial pressure.
Although symptoms may be the best effort of the organism to defend itself at that time, it is not usually effective to simply let the body try to heal itself. Most often, some treatment must be provided to help nurture, nourish, and augment the body’s own wisdom. The challenge to physicians, healers, and patients is to determine when to help aid this inner wisdom of the body and when to intervene to make certain that the body does not harm itself.
One can view the human body in one of two fundamental ways: as a typical biological organism that is subject to the usual laws of physics, chemistry, and biology, and therefore understandable through systematic investigation; or as some sort of mystical thing infused with an elan vital, subject to the whims of the supernatural and fundamentally mysterious. It’s pretty easy to verify which is a better model of reality, and which is a fundamentally arbitrary fantasy.
What Ullman is leading to is a fetishization of symptoms. He elevates the subjective experience of illness to a magical force for good. I have bad news for you, Dana: symptoms are a biological phenomenon which are neither inherently good or bad.
Nesse and Williams show how our symptoms and seemingly normal body functions work as important defenses:
- Fever is an important, even vital, defense against infection.
- Tears help wash and cleanse the eyes.
- The respiratory system is bathed in antibody and enzyme-rich secretions that are propelled up and down the throat and bronchial tree so that invaders are killed.
- The ears secrete an antibacterial wax which helps to fight infection.
- The frequent washing of the mouth with saliva kills some pathogens and dislodges others so that the stomach’s acid and enzymes can destroy them.
Without having to tell the bodymind what to do, our innate survival instinct has developed sophisticated responses to both old and new infections and stresses.
No, no, no! I’m wondering if this guy is even educable. Fever is not some magical defense against infection. Fever is (usually) caused by the release of certain cytokines as a reaction to many different stimuli, especially infection. There is no evidence that suppression of fever prevents healing. The “discovery” that tears help cleanse the eyes his hardly groundbreaking. None of these support his assertions about our “innate survival instinct”. Now, if Ullman had actually bothered to learn some immunology, he’d be blown away by the beautiful truth. Our bodies have evolved very sophisticated defenses against malignancy and infectious disease. The truth is much more complicated and interesting than Ullman’s oversimplification.
This type of teleologic thinking is child-like. Confounding a reaction with a purposeful, beneficial response is idiotic. For example, hypertension can cause compensatory thickening of the heart muscle, analogous to a biceps that grows with weight-lifting. Unlike a biceps muscle, this thickening is not beneficial. While it temporarily keeps the cardiac output up, it leads to accelerated heart damage, and eventually heart failure.
Having established his fundamental misunderstanding of biology, Ullman tops it off with praise for his pet medical cult, homeopathy.
The implications of recognizing that symptoms are efforts of the body to defend itself are significant. Because some conventional drugs work by suppressing symptoms, these drugs tend to provide helpful temporarily relief but tend to lead other new and more serious problems by inhibiting the body’s defense and immune processes. Such drugs should be avoided except in dire situations or in extreme pain or discomfort when safer treatments are not working fast or adequately enough.
In other words, based on his own fantasy about how the body works, doctors have it all wrong, but thankfully, he has all the real answers without having to perform all that pesky science.
Because symptoms are adaptations of the body in its efforts to defend and heal itself, it makes sense to use treatments that mimic this wisdom of the body. Ultimately, homeopathic medicine is a well-known therapeutic modality that honors this wisdom of the body. Homeopathy is a type of “medical biomimicry” that uses various plant, mineral, and animal substances based upon their ability to cause in overdose the similar symptoms that the sick person is experiencing.
This only “makes sense” if you buy into the false assumptions about human biology.
There is no way to state this forcefully enough: Dana Ullman is an ignorant twit who leads a fringe medical cult which promulgates dangerous falsehoods.
But HuffPo doesn’t stop with Ullman. Dr. Frank Lipman is pouring out volumes of ignorance. Lipman is a self-proclaimed expert in preventative health care. I emphasize “self-proclaimed” because he doesn’t seem to understand much about the subject. Doctors must be able to think independently. They must be able to look at the data, look at the recommendations of others, and apply these to individual patients. While one patient might “by the book” require a particular type of medication, you may know that this particular patient won’t do as well for one reason or another. But one cannot ignore evidence.
Lipman starts out with the predictable but clearly false claim that he is not “anti-vaccine” (instead being pro-vaccine safety and freedom of choice, setting up the false dichotomy implying that the rest of us are against safety, freedom, and presumably the American way). He then goes on to forcefully, in bold typeface, declare that most of his patients should not get the swine flu vaccine (I can hear Rebecca Watson’s voice in my head doing the voiceover of the capslock—good lulz). A generous person might take this information and think, “Gee, perhaps he has a geriatric practice so that most of his patients don’t fall within the current evidence-based recommendations.” That would be stretching generosity to the breaking point. He goes on to discuss why he anti-vaccine (in this case). But let’s talk a bit about flu and about prevention from, you know, an expert.
Let’s start with what swine flu is and is not. Every year, influenza sweeps across the world, affecting the US most strongly in the winter months. It causes at least 35-40 thousand excess deaths every year, and even more hospitalizations and lost days of work and school—and all that is in a “typical” year. In typical years, flu is most brutal on the very old, very young, and chronically ill. Swine flu follows a different pattern. It isn’t any less virulent or deadly than seasonal flu, but attacks a much greater number of people, especially those who don’t usually suffer much during a typical flu season. It also has refused to confine itself to the normal flu season, having simmered all through the summer. Vaccination helps prevent illness, hospitalization, and death due to influenza, so each year we formulate a vaccine based on the current circulating strains. To what extent vaccination is beneficial is an open area of investigation, but that it helps is clear.
Vaccination is an important tool in prevention of morbidity and mortality. Prevention is generally discussed as being primary or secondary. Primary prevention is the prevention of disease as you might typically think of it. If you can prevent someone from developing diabetes, polio, or heart disease, that is primary prevention. Once someone has a particular disease, preventing further episodes is secondary prevention. If my patient has coronary artery disease (say, having had a heart attack in the past), I can I practice secondary prevention by treating them with certain medications and with good health habits that reduce the risk of further heart attacks. There is another category—tertiary prevention—which usually refers to preventing a disease which complicates another. Diabetics are prone to heart disease, and there are ways to prevent heart disease in diabetics.
So let’s see what our “expert” in prevention says about flu shots.
1) At this stage, for the most part the swine flu seems benign.
Over a million people in the US have already come down with swine flu, many of them without even knowing that they had it. The vast majority of people who get the swine flu recover after a week or so of high fever, aches, and respiratory distress. It’s not pleasant, but except in rare circumstances, it is not fatal. Most people who’ve been infected by swine flu think so little of it, they believe they just had a really bad cold or a regular flu. So unless the swine flu evolves to a much more virulent form, there’s no need for mass vaccination.
Given what we know about the flu, this is foolish. Yes, swine flu is about equally as virulent as the usual flu—that is, it causes a great deal of excess significant illness and death. What threshold does Dr. Lipman, as a prevention expert, recommend for preventing a preventable disease? Is there a certain prevalence threshold? A certain virulence threshold? Apparently, his recommendation is based on his “feeling” that it is “rarely fatal” and “relatively mild”.
2) We don’t know if the vaccine will be effective.
Vaccines are only useful against the specific viral strain that was available at the time of their manufacture. But influenza viruses mutate quickly, and as the WHO has already said, the real concern with H1N1 swine flu is that it will combine with seasonal flu in the Fall, creating a new strain that will of course be immune to all available vaccines.
That reasoning is, in a word, stupid. The reason we need a new vaccine every year is that the flu changes. The reason we know which strains to vaccinate against is through careful public health surveillance. We do this fairly successfully most years. This year there is a seasonal flu vaccine based on the current strains, and a separate swine flu vaccine based on the fact that swine flu is still circulating widely. It has been tested as safe and effective, and is developed and produced just as all previous flu vaccines. To take the nihilistic view that because the flu mutates we should ignore decades of evidence and experience and just give up is the height of arrogant ignorance.
3) We don’t know if the vaccine is safe.
The FDA has authorized an expedited approval process for the swine flu vaccine but we don’t know yet if it is safe. Even GlaxoSmithKline, one of the vaccine manufacturers has said, “The total population studied in clinical trials will be limited, due to the need to provide the vaccine to governments as quickly as possible. Additional studies will therefore be required and conducted after the vaccine is made available.”
In other words, the only thing that is safe, is to say that no one knows. Since it’s never been used before and they have not had time to conduct any sufficient human testing, by getting vaccinated you are being a human guinea pigs.
That is simply untrue. This vaccine has been developed and produced just as previous vaccines have, and there is no reason to think that it is any more or less safe. To take this particular paranoid view is to ignore the science and the evidence.
His next point is either completely ignorant or sinister: vaccine manufacturers are insulated from liability, therefore they have no incentive not to hurt you. The reason vaccine manufacturers receive immunity is so they will still be able to provide this not-very-profitable service. Anti-vaccine cultists would sue the vaccine makers into oblivion, or clog the courts trying. Instead we have a rational surveillance program. Since significant vaccine-related side effects are vanishingly rare, it is only on mass release that rarer ones may become apparent, therefore we have a system for monitoring vaccine safety. Thankfully, serious side effects of flu vaccine are not distinguishable from the baseline incidence of these problems, and are rarer than serious flu-related illness.
The evidence shows that the most effective primary prevention of influenza is vaccination. Still, it’s rather more invasive than, say, dietary changes. Is there any evidence for other primary prevention strategies? The answer is essentially, “no”. Lipman gives a heap of worthless advice about “phytonutrients”, vitamin D, and exercise, some of which is plausible but not supported by evidence, and some of which is implausible enough to be laughable.
When you read the comments to a post like this, you can see that some will never be persuaded by evidence or science—they hold fixed-false beliefs which people like Lipman feed. His self-declared status as an expert in prevention is irresponsible. He makes no evidence-based recommendations, and many that are downright dangerous. He illustrates one of the fundamental contradictions in the alternative medicine movement: the claim to be pro-prevention but actions that completely belie the claim. It would be sad if it weren’t dangerous and irresponsible.
But the Huffington Post is full of dangerous and irresponsible medical writing. There’s nothing random about it—it is an organized and concerted effort to impose a cult-like vision of health on their readers. This would be nearly tolerable if it were a fringe website, but it’s not—it’s a wildly popular news outlet, and Huffington uses this to propagate her cult views. It’s not illegal, but it is immoral.
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