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More on the Bravewell issue

Being on the West Coast places me (and Harriet?) at disadvantage in responding to recent developments, as I find out about them later in the day, if that day. (Retirement doesn’t help.)

First I had some comments on the WSJ article on “CAM,” the NCCAM by Steve Salerno and the response by the pseudoscince leadership. The 4-author response revealed political tactics used by quacks and sectarian medicine advocates to answer with straw man points and especially to ignore what they cannot answer.

In their response to Salerno’s article they accused him of being unqualified to object to “CAM” because he was only a reporter. Fact was that most of his points were from my writings, which Slerno frankly acknowledged. The several rebutting authors never mentioned my name. Of course not. (That it was lost in the SBM analyses is understandable.)

And that is the frank dishonesty we are dealing with when we face off with these characters, who now have the ears and eyes of the Institute of Medicine, academic deans and professors, and government. They are smiling as they read this.

There is no mystery as to why the Institute of Medicine is allying with Bravewell for the February “Summit.” Bravewell paid – for the conference plus. The 2006 IOM/NCCAM conference on “CAM” in the population cost NCCAM over $1 million, although such a conference would usually cost $200K- $400K. I know because the latter fugures were quoted to me as a starter for the “CAM” sectarian medicine conference I proposed to IOM.

IOM is a private organization as we have pointed out before, with its sustenance from government and private grants, for doing these kinds of investigations and reports. We are finding that some (many?) of its projects have politically inspired agendas. I suspect the reports on iatrogenic deaths, hospital infections, etc. had such geneses. Bravewell is paying the way to “Integrative”/ sectarian acceptance.

Below is a partial reproduction of a letter I sent to Harvey Fineberg of the Institute of Medicine of the NA.

January 19, 2009

Harvey Fineberg, MD, PhD.

President, Institute of Medicine

National Academies

500 Fifth Street

Washington DC 10005

Dear Dr. Fineberg,

I write to express opinion on the recent alliance with the Bravewell Collaborative and the scheduled February, 2009 conference on Integrative Medicine.”

I express concerns in two general categories; the problem of the “Integrative”/ “Complementary and Alternative Medicine” (CAM”) movement, and the Bravewell organization itself.

After thirty years or more of claims and investigations, we now know that depending on definitions, there are few to no claims of sectarian systems and implausible claims that have been found effective or worthy of inclusion in a modern medical system. A loosely-associated international group of skeptical medical scientists have been investigating and reporting on sectarian and implausible claims for decades, and our literature is available through systematic searches and on-line references. We now have the most plausible explanation for apparent sectarian successes – poorly conceived, biased studies and irrational, group-enhanced, belief systems. The former are error-generated and correctible, but the latter are resistant to resolution and correction. Both are soiled by concomitant misrepresentations. I can supply more detailed analyses and commentary at your convenience. Suffice to say that tolerance of this irrationality has reached the highest levels of medical academia as well as of government. I am sure you are aware of this.

A corollary issue is the way in which advocates of this system have altered the language of description, have relegated rational criticism to off-bounds or have ignored commentary, and have altered a segment of public opinion through advertising and common propaganda. Sectarian advocates are trying to systematically alter the rules of bio-medical science, research and practice.

The Bravewell Collaborative, a relatively recent actor supporting these techniques has been literally buying its way into medical schools – faculties and curricula. It sponsors almost forty medical school programs of classes, courses, research, and post-graduate training – training students and physicians in irrational thinking and integrating belief systems. From your reactions on the Bravewell video introducing the conference, I am relatively certain you are aware of most of this. I hope you are aware also that dozens of other, smaller though wealthy foundations also sponsor programs in unscientific medical and nursing education. Samueli (homeopathy, UC Irvine,) Osher (Harvard, UCSF, many undergraduate university education programs such as Santa Clara,) Fetzer (several extra-university conferences,) Templeton (religion/science unification studies,) all offer millions of dollars in education, supplementing the $110-120 million/year congressional output through the NCCAM and an equal amount through the Ntional Cancer Institute.

However, I am not sure that you and the IOM academic staff have the degree of concern the situation demands. The fact is that Bravewell and the others are corrupting the medical educational process with an ideological approach to medicine never before seen – at least since the Enlightenment. The editorial comment in Nature, December, 2000 by Prof. Robert Brown of U. Toronto decried the “Corruption of the Academic Commons” by Templeton, among others. Yet no reaction has occurred.

In the Bravewell video, your disagreement on goals was detectable despite the attempts of the advocates – Ms. Mack and Dr. Snyderman – to cloud their intentions. The intent of Bravewell, and of the NCCAM, which sponsored the previous IOM project, is to use establishment organizations of medicine ands science to further their medical ideologies and to transform the American medical system away from a basis in science and rationality. The reasons are multiple, but include economic ones.

Several years ago Stephen Barrett MD and I separately analyzed both the membership and the Executive Summary of the IOM project on “CAM.” They are published on Quackwatch.com and in The Scientific Review of Alternative Medicine (Center for Inquiry and SRAM.org) More recent analyses of the errors and misrepresentations of Bravewell supporters and recipients can be found at the sciencebasedmedicine.com blog along with multiple negative opinions of the upcoming Summit.

I write now hoping that IOM will be able to present in any report a more balanced view of the present situation by adding a separate analysis of material presented at the February meeting, or by having advisors on pseudoscience contribute in a significant way. If Bravewell were truly objective and devoid of ideological commitment, it should be able to accept such an arrangement. I hope IOM can seriously consider some sort of resolution, and I would much appreciate a reply.

Sincerely

Wallace Sampson MD

Clinical Professor of Medicine (Em,) Stanford University

Posted in: Basic Science, Health Fraud, Medical Academia, Politics and Regulation, Science and Medicine

Leave a Comment (10) ↓

10 thoughts on “More on the Bravewell issue

  1. Zetetic says:

    Google “chopra drink urine” and see how many references you find! Why does the WSJ giving dignify this charlatan masquerading as a distinguished physician with a platform?

  2. wertys says:

    That slapping sound is the gauntlet rebounding off the IOM’s cheek.

    It will be interesting to see what if any the response is..

  3. DLC says:

    Well Done, Dr Sampson !

    question to think about: Who are these people, and where do they get their money ?
    I suspect the answer would be that they’re big supplement companies.

  4. I realize a lot of my comments on this blog are along the lines of cheerleading, but I LOVE seeing concerned doctors KICK BUTT verbally!!! :) This is an excellent letter; thanks for sharing!

  5. Wallace Sampson says:

    Thanks for the supporting comments. I am trying hard to keep my mouth shut and fingers motionless about several issues that underlie what we see on the surface of these blog entries.
    But up comes irresistable gurge to blog forth…breaking through years of silent self-imposed gag.

    The NCCAM persists in clear view of disconfirmation of its raison d’etre.
    Each year sees a net gain in influence by sectarian medicine within academia and government.
    Promotion of the movement for a national or single payer health plan (medical plan if we would use proper language) proceeds, promoted as a solution to a crisis that does not exist. It carries with it a regimentation of thought not before seen in this free society, and unrecognized by most of us.
    People – that still includes physicians – reared in today’s computerized and uncritical med schools – are now trained – submerged – comfortably in groupthink.
    Maybe worse, the quacks have usurped or the very same language in their plaints and promotions for “freedom of choice” and freedom from the “rigidity” of scientific and rational thought. There are a myriad of other politically motivated movements, all pushed by organized special interest groups, complaining of being limited and constricted by what we see and know is civilization’s greatest product or contribution – scientific thought.
    What we see now is not the isolated charlatanism acting on a few gullibles in previous centuries, but exactly what organized postmodern pseudoscience predicted 40 years ago (yes, 40…or more.) A changed paradigm.
    And they are saying “Deal with it”

  6. Joe says:

    Wallace Sampson on 27 Jan 2009 at 3:58 pm wrote “Promotion of the movement for a national or single payer health plan … proceeds, promoted as a solution to a crisis that does not exist.”

    Am I to understand that you think 40 million uninsured people is not a crisis?! Am I to believe that uninsured people and those without the best insurance, nonetheless, receive the best heath care?!! (For the record- I do not.) Do you think they just don’t matter? I don’t think so, and I doubt you do, too.

  7. Wallace Sampson says:

    Joe,

    The questions imply certain implications not implied. (!) The situation does not in my opinion mean a crisis. What concerns you I hope, is a defective system, not a crisis. And all systems have defects.

    The estimated 40 million include young people who elect not to have insurance, the unemployed, people on welfare, all of whom qualify for Medic-aid, and illegal aliens who amount to 12-20 million. If we have a crisis, it is not what is being called crisis for political purposes.

    The present situation is defective but defects can be corrected. There is no excuse for anyone to be without some sort of care. Laws prevent that. (I spent plenty of time treating people in that category – for free at times, at a loss at others.) Nevertheless, it is being played by organized pseudoscience and quackery who are lobbying hard for coverage under a centralized political system. Once covered, it would be almost impossible to be reversed. In a non-governmentally controlled system, with adequate competition, and adequate ground rules for doing business (laws) there should be a variety of elective coverages available.

    Not mentioned in my IOM letter was the quackery push for the 1989 OTA “Unconventional Cancer Treatments” investigation. That led directly to the OAM and NCCAM, which were in the planning of that push.

    A crisis implies some concept of timely urgency. The term “crisis in medical care” dates back – way back. Over 3,000 “Health care Crisis” medical literature entries date back to 1965, with recorded papers even in 1954. The crisis has been of cost, availability, and other temporary and correctible defects; to quacks, the inability to get insurance payments.

    The term is being used for legitimization of “personalized,” “de-professionalized’” care in the guise of cheaper care. We have no organized response to this. Yet.

  8. David Gorski says:

    Promotion of the movement for a national or single payer health plan (medical plan if we would use proper language) proceeds, promoted as a solution to a crisis that does not exist. It carries with it a regimentation of thought not before seen in this free society, and unrecognized by most of us.

    Wally, as much as I agree with the rest of what you say in this comment, I’m going to have to disagree strongly with you on this one point. You appear to be saying that there is a “regimentation of thought” among supporters of a single payer system comparable to CAM promoters. I realize that in your followup comment you made it more clear that you meant the attempts of CAM/IM advocates to slip their agenda in along with the push for health care reform, be it single payer or something else. However, to refer to a “regimentation of thought not before seen in this free society” in the context of promotion of a single payer plan is an enormous exaggeration at best, and completely wrong at worst. (I can think of several examples of severe “regimentation of thought” in U.S. history, and the support for single payer doesn’t even come close to them.) That’s why I’m going to give you the benefit of the doubt and assume you didn’t really mean to compare advocates of single payer to quacks and to inform you that, to me at least, that’s sure what it sounded like you were doing.

    Be that as it may, you’re conflating two different issues. The first is whether a single payer system would solve our current difficulties, while the second is the attempts of Deepak Chopra, Andrew Weil, and other sectarian advocates of pseudoscience to hijack efforts to pass a single payer plan by inserting language into any legislation creating such a plan that would force the government to pay for their woo as part of an overall package of “wellness” care. Indeed, I wrote a very long article for SBM on just that latter topic. Personally, my view is that, just because zealots have been trying to insinuate their agenda into a plan is not, in and of itself, a reason to reject a plan. Ideologues try to hijack plans and reforms all the time. If the reform is good on its own merits, the solution is to prevent it from being hijacked, not to throw the baby out with the bathwater by abandoning the plan.

    As for your analogy between the “regimentation of thought” involved in advocating a third party payer and the “regimentation of thought” of CAM advocates, I’m sorry. I just don’t buy it. It’s gross hyperbole. There are valid political arguments on either side of the single party payer issue, not to mention valid economic arguments and evidence that can be marshalled on both sides. This is in distinct contrast to CAM/IM, where, for the vast majority of the wildly implausible remedies that fall under the CAM rubric, there are no good scientific or evidentiary arguments. Your conflation of the two just doesn’t make much sense on that score, either.

    The questions imply certain implications not implied. (!) The situation does not in my opinion mean a crisis. What concerns you I hope, is a defective system, not a crisis. And all systems have defects.

    The estimated 40 million include young people who elect not to have insurance, the unemployed, people on welfare, all of whom qualify for Medic-aid, and illegal aliens who amount to 12-20 million. If we have a crisis, it is not what is being called crisis for political purposes.

    The present situation is defective but defects can be corrected. There is no excuse for anyone to be without some sort of care. Laws prevent that. (I spent plenty of time treating people in that category – for free at times, at a loss at others.) Nevertheless, it is being played by organized pseudoscience and quackery who are lobbying hard for coverage under a centralized political system. Once covered, it would be almost impossible to be reversed. In a non-governmentally controlled system, with adequate competition, and adequate ground rules for doing business (laws) there should be a variety of elective coverages available.

    Call it what you want, but a very serious problem does exist, and it is rapidly getting worse with the economic meltdown. Those of us still taking care of patients know the problem of the uninsured is bad and getting worse, and the objective numbers support that view (for one thing, it’s now estimated to be 46 million uninsured, not 40 million). And if I, a specialist (and not even a full-time surgeon given my research responsibilities) perceive it, my friends in primary care (like our coblogger Peter) tell me that, whatever I see, the problem of the uninsured is far worse in primary care. Of course, we’re both in the Detroit area, which has, if I recall correctly, the highest unemployment rate in the nation and has been depressed economically for several years now, but I saw the same problem in New Jersey when I worked there. It just wasn’t as acute. I, too, provided a lot of unreimbursed care. In fact, I used to joke that I was the surgeon to the uninsured back when I worked in New Jersey. Your mentioning illegal aliens is also exaggerated. In fact, 80% of the uninsured are native or naturalized U.S. citizens, and roughly half of them are insured, making your counting the entire 12-20 million of them as uninsured dubious at best. They also have a tendency to seek out the very CAM/IM that we all consider useless because they can’t afford scientific medicine, care delivered by folk healers known as curanderos. Lack of insurance arguably leads to the increasing popularity of woo, because woo is much cheaper.

    Believe it or not, I once thought as you did, namely that a single payer plan is anathema–socialized medicine, designed to control physicians and patients! The free market is always better, right? However, having practiced a while, having seen how bad things get when a hard-working, self-employed person who does not make enough to afford reasonable health insurance falls ill, I’m no longer so sure. In fact, I daresay I’m no longer so dogmatic about the glories of the free market system as I was 25 years ago. Does this mean I now support a single payer plan? Not necessarily. It does, however, mean that I no longer dismiss it out of hand as a solution to our current problems as I once did. It means that my mind is at least open to consider a single payer plan on its merits as one possible solution to our currently broken system. I suppose that might mean in your eyes I’ve fallen victim to the same sort of groupthink that CAM advocates often show. If I’m correct about that, so be it.

    In fact, I find it very odd that in essence dismiss the problem of the uninsured by saying that the law demands that care has to be given to people. While it is true that most patients without insurance who show up with a serious medical condition will usually be treated regardless of their ability to pay, thanks to EMTALA, routine medical care is very hit or miss for the uninsured. Often it’s virtually impossible to find. (There are only so many free clinics to go around.) Moreover, while we physicians frequently provide unreimbursed care, hospitals are often not nearly as generous. It’s also rather ironic to me that you would extoll the benefits of limited government in the health care system but be seemingly completely unperturbed by such a massive government mandate that requires hospitals and physicians to provide free care for patients who cannot pay but then doesn’t actually reimburse enough to cover the costs of providing that care. It’s the ultimate unfunded (more precisely, underfunded) mandate, to the tune of $34 billion worth of uncompensated care a year.

    This brings me to another aspect of this. I’ve come to realize that we in the U.S. already have the worst of both worlds. We already have government-mandated price control in medicine. Medicare sets rates for DRGs, and all the third party payers start their negotiations somewhere around what Medicare pays, leading to a clustering of reimbursements around the Medicare rate. (Indeed, in negotiations, they will often argue over whether a given insurer will pay 1.1x or 1.15x the Medicare rate for a given service.) We also have the government mandating what will and will not be reimbursed, along with insurance companies, many of whom model their reimbursement after what Medicare will and will not pay for. Meanwhile, those reimbursements are being relentlessly ratcheted down. Indeed, a couple of general surgeons I know no longer do inguinal hernias because the reimbursement doesn’t cover their costs.

    So, aside from boutique practices that reject Medicare, Medicaid, and all third party insurance, physicians in the U.S. already function under two of the major downsides of a government health care system: government-set price controls and government- and insurance-mandated regulations on what services are and are not reimbursed. Yet we do so without the benefit of a single payer system, namely universal coverage, leading to something like 40+ million uninsured. Truly, the worst of both worlds. Is single payer the solution? I honestly don’t know, but I no longer dismiss it as a potential solution. Certainly the free market arguments, yours included, sound much less convincing to me than they once did 20 years ago.

    Finally, given that this is science-based medicine, we should look at the evidence. Do you have any evidence that single payer systems result in worse outcomes? The evidence that I’ve examined thus far is fairly strong that they do not, at least not in developed, European countries. Moreover, there are many “flavors” of single payer, ranging from the rather severe Canadian system where no private insurance or private pay is allowed (something I don’t think I could ever support, although even Canada is experimenting allowing some private insurance) to the U.K., where there is the NHS existing alongside many private insurance plans. Single payer is not a black and white phenomenon. Also, do you have any evidence that care in countries with single payer plans is any more “deprofessionalized” than it is here in the U.S.? Perhaps an even better question to ask is whether there is currently or has recently been a system that is totally free market. If so, how does it work? What are its outcomes?

  9. khan says:

    >>This brings me to another aspect of this. I’ve come to realize that we in the U.S. already have the worst of both worlds. <<

    I admire your ability to change your mind as evidence accrues.

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