Jun 11 2008
Recently I have been generally critical of how mainstream media deals with scientific topics. Science is often complex and requires hard work and diligence on the part of a journalist to get the story right. In recent years mainstream news outlets have been downsizing or eliminating their science journalists and tasking general reporters and editors to handle science stories.
Meanwhile, as science progresses it grows more complex and challenging to distill for a lay audience. At the same time there are growing pseudoscientific institutions and social forces making it even more difficult to sort out the reliable from the nonsense. This is especially true, in my opinion, when it comes to medical reporting of controversial treatments and claims.
In our evaluation of 500 US health news stories over 22 months, between 62%–77% of stories failed to adequately address costs, harms, benefits, the quality of the evidence, and the existence of other options when covering health care products and procedures.
Therefore the media gets the story substantially wrong 2/3 of the time. This is largely a problem of quality control. When it comes to reporting of so-called “CAM” – complementary and alternative medicine, otherwise called “integrative” or “holistic” medicine (all labels useful for marketing and promotion) the media often buy into the marketing propaganda of proponents without seriously questioning it. This would be the equivalent of a political journalist accepting press releases coming out of a presidential campaign without ever questioning the facts or premises they contained.
I was recently sent this article called Local healthcare systems incorporate holistic medicine, published recently in the Toledo City Paper. I have read dozens of almost identical new reports – as if local details are being plugged into a generic template containing all the pro-CAM talking points. This article, therefore, is as good as any as an example of the poor journalism and mindless acceptance of propaganda typical of reporting on such topics.
East Meet West
The article’s author, Kevin Moore, frames his piece as the contrast between “Eastern” and “Western” medicine. Immediately he is establishing the premise, perhaps without realizing it, that different medical treatments are a matter of culture, of genuine alternatives that are a matter of preference only. He writes:
Using plants and herbs for medicinal purposes is the oldest form of healing on the planet. The Chinese began employing natural healthcare for the first time some 4000 years ago. Around 600A.D. Islamic physicians developed a far more advanced system of herbal-based drugs and remedies. These methods contrast greatly to those developed in Europe and America using hardened disciplines such as chemistry, anatomy, and psychology.
In order to emphasize the contrast between East and West he plays a little loose with the fact. Actually Islamic culture was the repository of much ancient knowledge of the hard sciences of anatomy and chemistry, as well as medicine. Also, herbal-based drugs (one characterization the author gets right – herbs are drugs) have been used in Europe and America straight through to modern times. He is creating a false dichotomy between East and West to support his premise.
The real distinction to be made is between science-based medicine and superstition or philosophy-based medicine – something which all cultures had throughout the world. The only rational approach, regardless of modality, is to rely upon science as the arbiter of what works and what doesn’t work, and to dispense with the pre-scientific superstitions and health philosophies of the past – whether it be humoral medicine favored in Europe or Chi favored in Asia.
The CAM Umbrella
America has recently experienced an almost epidemic interest in these ancient approaches to healing. Traditionally, the subscribers to this “back to Earth” kind of medicine have received the stereotype of unkempt hippie herbalists of the cultish sort who delve too heavily into a certain color-enhancing star-shaped leaf. While certainly amusing to consider, this perception is actually rooted in tremendous ignorance, if not bias. Dr. Mounir Elkhatib, head of Promedica’s Great Lakes Center for Integrative Medicine, said that holistic medicine is becoming a rapidly expanding science within the medical community.
First he establishes what is a straw man, that CAM proponents are viewed (using the passive voice so it is not clear exactly who views them this way) as drug-using hippies. While certainly it seems that the new-age culture has disproportionately embraced CAM, so have upper-middle class suburbanites (those with disposable income) and those who prefer to take a spiritual approach to healthcare. Acceptance of CAM is largely a matter of either ideology or gullibility, not being a hippie.
After setting himself up with a rather lame straw man of the supposed contrary view, Moore then informs us that “integrative medicine” is a “rapidly expanding science.” He takes this premise without question, when in fact this is at the very heart of the actual resistance within the medical community to the modalities that are implausibly grouped under the various CAM banners. Have such modalities been verified by science? The answer is clearly no. All of the major CAM modalities – acupuncture, homeopathy, chiropractic, and therapeutic touch, have yet to rise above the bar of science-based medicine.
Homeopathy and therapeutic touch have essentially a non-existent plausibility and the distribution of clinical evidence is consistent with no real effect. Chiropractic probably has a non-specific benefit for symptomatic acute uncomplicated lower back strain – but the philosophy of chiropractic (innate intelligence blocked by unseen subluxations) has failed to make any progress in 100 years of study. Acupuncture’s core claim – manipulating the flow of chi – is in the same boat as innate intelligence. So far the evidence for efficacy for any indication for acupuncture has been either negative or mixed, but a modest and non-specific counter-irritation type effect, while not established, cannot be ruled out.
What about herbal medicine? The use of plant-based pharmaceuticals is not properly labeled as alternative. Like nutrition, this has been co-opted by CAM proponents to give a vast assortment of unscientific modalities the sheen of legitimacy. What is alternative (meaning unscientific) is using herbs for indications that are not evidence-based, but not herbs themselves.
The Argument Ad Populi
Moore then quotes a CAM proponent, Dr. Mounir Elkhatib (never mind giving equal time to opposing views) as saying:
“In 1993, the New England Journal published an article that surveyed the use of alternative medicines in this country. Almost 40 percent of the public uses at least one kind of herbal supplement, and those people spend close to $11 Billion every year in health food stores. In response, the National Institute of Health started the National Center for Complementary and Alternative Medicine. There is a great deal of research going on, and this area is becoming very evidence based.”
This is highly misleading. The 1993 NEJM article he is referring to is the infamous Eisenberg study, which instantly became the cornerstone of the argument ad populi for CAM. The study showed that 34% of those surveyed had used at least one “unconventional therapy” in the past year. What is misleading about how the study is presented by the media (including Moore’s recent piece) is what Eisenberg considered “unconventional.” Take a look as the results table from the study.
The only substantial numbers in there are exercises and prayer, which don’ t belong there at all. The 34% figure is excluding exercise and prayer, but still includes relaxation, massage, and weight-loss programs as significant contributors, which bloats the numbers. The only hardcore CAM modality that reaches double digits is chiropractic, most of which is for symptomatic treatment of back strain. If the use of straight chiropractic for the treatment of subluxations were pulled out (as it should be) the number would be much lower. Look at homeopathy – 1%, and acupuncture – <1%. These are not impressive (the numbers are likely higher now, but not by much).
But the strategy is clear – make an argument for the popularity of CAM and inflate the perception of popularity by including a wide range of modalities, many of which can be scientific or are, at worst, a bit soft. Then the serious unscientific modalities, like homeopathy, can come along for the ride. In many way it’s a bate and switch, and the media have largely bought it without a hint of journalistic skepticism.
The next statement is a demonstrable historical falsehood – that the NIH started the National Center for Complementary and Alternative Medicine (NCCAM, formerly Office of Alternative Medicine) in response to Eisenberg. What happened was that a few ideological senators (Orrin Hatch, for example) pushed through legislation forcing the NCCAM down the throats of the NIH. This was followed by protest by NIH scientists which resulted in a one time decrease in the NCCAM budget (at that time the OAM), but the political forces soon overwhelmed the scientific resistance and the NCCAM has grown and flourished.
Now CAM proponents have rewritten history, pretending that this was a response to public demand by NIH scientists – and the media happily oblige the fantasy.
Moore quotes Dr. Elkhatib some more (the article could be an advertisement for Dr. Elkhatib’s clinic):
“All of these treatments are part of something larger that we promote called holistic wellness.” says Dr. Elkhatib. “That is a general attitude of total wellness. Lifestyle is so crucial to this. This includes every kind of well being: physical, emotional, spiritual, sexual, intellectual, and financial wellness.”
The notion that unscientific medicine is more holistic than medicine founded upon sound evidence and scientific principles is one of the greatest marketing scams of recent history. As Mark Crislip has pointed out, science is truly holistic because by necessity it works as a unified system of knowledge that must be internally consistent at all levels. CAM modalities are usually based upon a very narrow philosophy of health and illness, and also are often mutually incompatible with each other. Further, good science-based medicine is appropriately holistic in that it considers the whole person, something which has been referred to as the “biopsychosocial” approach.
I routines have discussions with my patients (within the confines of science-based medicine) addressing their physical, emotional, sexual, intellectual, and even financial wellness. I also consider their history and treatment in the context of their cultural and social situation. I do not cross the line into their spiritual lives, however. I do not think that is the proper role of a physician.
Scientific medicine is properly holistic. Unscientific medicine is extremely un-holistic – it often neglects the biological aspects of illness. In fact it often neglects the biology that is the true underlying cause of illness, putting in its place a comforting fantasy. It is literally true that “holistic” in the context of much of CAM is nothing more than a clever and successful marketing strategy.
There is much more, but as it is easier to create a misconception than to correct it, I must limit myself to the points above. I have come to expect poor reasoning and factual errors from the promoters of unscientific methods. But I will never accept the low standards of journalism that allow for the gullible presentation of nonsense without even a nod to token skepticism, let alone proper balance. Journalists have been handed talking points by ideologues who are selling products and services, and a belief system to go along with them. They are the same points we have been hearing for years – CAM is very popular, scientific validation is just around the corner, we want to integrate the best of both worlds, etc. A competent journalist should stop to ask – are these claims actually true? Are there any credible critics with another perspective?
Otherwise they become unwitting accomplices to a deadly scam.
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