Mar 02 2009
This was cross-posted at White Coat Underground, despite the topic having been covered by Dr. Gorski yesterday. The topic is important enough that many of us in the medical blogosphere are going to be talking about this.
Remember when President Obama said something about returning science to it’s rightful place? Well, our new president has a real tough climb ahead of him. The previous administration shoved science aside for political expediency and religious ideology. Now, forces in the president’s own party are trying to insert their own quasi-religious beliefs into health care reform, leaving science in a whole different place altogether.
Here’s the deal. Some years back, Senator Tom Harkin (D-IA) helped set up the National Center on Complementary and Alternative Medicine (NCCAM). The whole idea of setting up such an agency is a bit quixotic—after all, the National Institutes of Health already study health science. As my colleagues and I have written many times before, the very idea of the agency seems ridiculous. Many, many studies have been funded which fail basic tests of plausibility and ethical propriety. Also, a huge percentage of the studies funded fail to ever publish their results. Still, some studies have been published, and more often than not, they find that the “alternative” modality being studied fails to behave better than placebo. That’s probably the sole redeeming quality of the agency, but not enough to keep it open, as these studies could have been done under the auspices of the NIH.
It turns out that Senator Harkin agrees with me on one point: NCCAM is failing to validate many alternative modalities. The difference is that I find it heartening and Harkin finds it disturbing:
“One of the purposes of this center was to investigate and validate alternative approaches. Quite frankly, I must say publicly that it has fallen short. It think quite frankly that in this center and in the office previously before it, most of its focus has been on disproving things rather than seeking out and approving.”(from last week’s hearings, time marker approx. 17:20)
Well, at least he’s honest. He comes right out and bemoans the fact that science hasn’t upheld his quasi-religious medical beliefs. He just doesn’t get it. If you choose to investigate a scientific question, you have to be prepared for “bad news”. You don’t get to decide the outcome before the fact.
But Harkin makes his goals very clear, from his prepared statement, to the “experts” from whom he took testimony.
Harkin makes clear that these hearing are meant to guide health care reform—this isn’t some show hearing. Let’s start with his prepared statement, and I’ll just touch on a few highlights.
“It is time to end the discrimination against alternative health care practices.
“It is time for America’s health care system to emphasize coordination and continuity of care, patient-centeredness, and prevention.
“And it is time to adopt an integrative approach that takes advantage of the very best scientifically based medicines and therapies, whether conventional or alternative.
This familiar trope is right out of the Gary Null playbook. There is no “discrimination” against alternative health care. In fact, alternative health care enjoys a lack of oversight and regulation inconceivable in any real health field. Still, many doctors (such as myself) do scorn altmed—because it is a fairy tale. There is no alternative medicine; only medicine that has been proved to work, and medicine that has not. Then he links his fantasy “discrimination” with reasonable goals, such as coordination and continuity of care, making it seem as if the “mainstream” medical community would throw out basic tenets of medicine along with radical cult practices, such as homeopathy. And his stated wish to take advantage of the best in science-based therapies is belied by his complaint that NCCAM has failed to validate his pet alternative practices.
He then invokes the meme of “giving people what they want”—you know, the old health care freedom gambit, where quacks argue that patients should be given the freedom to choose crappy care.
Harkin’s choice of speakers certainly shore up his credentials as a believer in cult medicine. Let’s take a look.
First up, Dr. Mehmet Oz, current darling of Oprah. The guy likes to make very nice sounding pronouncements which often have little to do with science:
Part of the reason is that Americans are twice as sick as Europeans as a people because of our chronic disease burden. Since lifestyle choices drive 70% of the aging process, most experts agree that we should focus on what we put in our mouths (food and addictions), how we tune our engines (exercise and sleep) and how we cope with stress (community and psychological growth).
Begging the question a few times, Doctor. Are Americans twice as sick as Europeans? What would it mean to be twice as sick? What is a “chronic disease burden”? What does it even mean that “lifestyle choices” drive the aging process? And 70%? The entire statement is meaningless, unscientific drivel. He focuses a lot on the wishful and empty topic of longevity medicine. And a visit from a quack wouldn’t be complete without an appeal to authority and a sales pitch—Oz shows a picture of a left ventricular assist device, the kind he has presumably installed in patients, to show what a bright guy he is. That’s great, but being an expert in cardiac surgery doesn’t make you an expert in preventative medicine. Then of course he shows a picture of his book. Maybe Congress should buy one for every American!
Next up, Dr. Mark Hyman, expert in “functional medicine”. Functional medicine is a newer approach to unscientific medicine, and rests on many of the common myths popular in various health cults, such as the myth that mainstream medicine only treats “symptoms” of disease and not the “disease” itself (whatever that may mean). Dr. Hyman invokes the language of Kuhn, calling for a “paradigm shift.” Here, let’s look at his own words (in the same testimony during which he calls for large-scale funding of his cult):
This way of doing medicine, or Functional medicine, is a system of personalized, patient centered care based on how our environment and lifestyle choices act on our genes to create imbalances in our core biologic systems. Those imbalances show up as the signs and symptoms we call disease.
That’s very pretty, but doesn’t actually mean anything. His testimony shows a complete lack of understanding of the actual causes of disease, and ignorance of evidence-based prevention and treatment. His “paradigm shift” would shift us right back to the 17th century.
Dean Ornish. They called in Ornish. Really it’s more of the same. He gives another impassioned plea for ending the madness, the madness of treating sick people.
Our research, and the work of others, have shown that our bodies have a remarkable capacity to begin healing, and much more quickly than we had once realized, if we address the lifestyle factors that often cause these chronic diseases. Medicine today focuses primarily on drugs and surgery, genes and germs, microbes and molecules, but we are so much more than that.
Genes, germs, microbes, molecules…all those hard, science-y things. Does he have a diet to keep me from throwing up in my mouth?
But because the above assault on science-based medicine isn’t enough, they called the bearded guru of Arizona, Dr. Andrew Weil. He, of course, delivers the same old story:
For practitioners of IM [integrative medicine], preventing disease is not an afterthought, it is the cornerstone of our practice – the physician and patient form an ongoing partnership to maintain health, rather than fight illness, and IM practitioners are trained to be agents of lifestyle change. We treat illness promptly and aggressively when appropriate, but always seek to maximize the body’s innate capacity to stay healthy and resist disease and injury.
Andy’s a great salesman. He knows how to tell the best kind of lie—the one that contains a kernel of truth. The implication that real doctors don’t focus on prevention is ridiculous. When I see my diabetics, I make sure I examine their feet (thereby preventing amputation), I make sure they see the eye doctor (preventing blindness), and I make sure their blood pressure and cholesterol is under control (preventing stroke and heart attack). It would be lovely if I could have prevented them from being diabetic in the first place, however some people have trouble with all those pesky genes and molecules and end up diabetic despite their best efforts.
This is a very disturbing development. A horribly anti-science Republican administration has been replaced by a Democratic administration that promised to respect science. They also have a real mandate for health care reform. If this is how they are going to use their mandate, to give their imprimatur to cult medicine and to marginalize science-based medicine, we might have been better off with the devil we knew.
Thanks to a commenter, we learn that the third largest contributor to Harkin’s campaign fund is Herbalife International.
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