David Gorski suggested I expand on a comment I left recently on one of his November posts. His subject was the then new documentary movie, “A Beautiful Truth.“ “Truth” is about the Gerson method – the dietary deprivation cum coffee enema cancer treatment developed by Dr. Max Gerson, a refugeee from Germany I the 1930s. His daughter, Charlotte now runs the Gerson Institute in Tijuana, Mexico. Gerson is one of the models for the Gonzales method recently reviewed by Kim Atwood.
I had previously referred to the movie in a prior post (1) (but in a different context. Here I’ll explore the movie from a different angle – with its partners, propaganda documentaries.
David called my attention to “Truth” plus another by the same producer – with trailers on You Tube. When I watched the trailers last year I saw myself interviewed briefly, but could not recall being filmed, or even identify where the scene took place. I had to email Steve Barrett, also in the movie, who reminded me about filmmaker Steve Kroschel’s visits 2-3 years before, although neither did he have strong memory of the interview.
Triumph of the Heart, as its name does not suggest, is about science. The book’s author, Jie Jack Li, is a medicinal chemist who meticulously reviews the history relevant to the discovery of lipid-lowering drugs. He spares no details, even recounting the amusing quarrels and quirks of the scientists engaged in the “apocryphal showdowns” leading to the manufacture of cholesterol in a laboratory.
The personalities of the various scientists and Nobel laureates described in the book are highly entertaining. From beating one another with umbrellas, to insisting on wearing blue clothing only, to egos so large and unappealing as to empty an entire academic center of all its promising young recruits, one has the distinct impression that brilliance does not go hand-in-hand with grace.
That being said, each of these scientists did seem to share a common approach to research: carefully testing hypotheses, repeating peer study results to confirm them, and patiently exploring complex biochemical pathways over periods of decades. The physicians, physicists, and chemists showed an incredible ability to doggedly pursue answers to specific questions – understanding that the results might influence human health. But even more importantly, they were each willing to invest their careers in analysis that may never lead to anything more than a dead end. In fact, the book is full of examples of great ideas, developed over decades, that did not lead to a marketable drug. In some cases the research was halted due to lack of efficacy, in others political forces or personal whims influenced the course.
Jenny McCarthy, regular readers of SBM know, has been a frequent target of criticism here. The reasons, of course, are very simple. She has become the most famous public face of the antivaccine movement, releasing a book every year or so since 2007 about how her son Evan has been “cured” of autism through the dubious biomedical treatments she’s given him and how it was vaccines that supposedly caused her son’s autism. Most recently, she’s releasing a paean to antivaccine views and autism quackery entitled Healing and Preventing Autism: A Complete Guide, co-authored by Dr. Jerry Kartzinel. Dr. Kartzinel, some may recall, wrote the foreword to Jenny McCarthy’s very first paean to autism quackery back in 2007 and was properly lambasted by Autism Diva and Kevin Leitch for writing
Autism, as I see it, steals the soul from a child; then, if allowed, relentlessly sucks life’s marrow out of the family members, one by one…”
Sometimes, in order to appreciate just how wrong antivaccinationist are, it’s best to let them speak in their own words. Nowhere recently have I seen a better example of this than in an interview with Jenny McCarthy published on the TIME Magazine website. In it, along with the usual invocation of the “toxins gambit” and appeals to anecdotal evidence over science, Jenny reveals that she clearly thinks it’s regrettable but acceptable that infectious diseases will return because of the efforts of her and her fellow antivaccine activists:
The LA Times recently published their analysis of data provided them by the state of California and found that there are pockets of high rates of exemption from vaccines among kindergarteners. In the US public schools require that all children receive the recommended vaccines. However, states can allow exemptions for the religious beliefs of the parents.
Over the years anti-vaccine activists have been successful in many states in expanding the rules for exemption. In California, for example, parents may seek excemption if they have “philosophical” objections to vaccines – which means there really isn’t any criteria beyond the parent’s wishes. The anti-vaccine movement has been active not only in pushing for the weakening of vaccine requirements but also in teaching parents how to use the laws to evade vaccination for their children.
The LA Times found that, while state wide the exemption rate was only 2%, exemptions were largely clustered in certain schools. They report:
In all, more than 10,000 kindergartners started school last fall with vaccine exemptions, up from about 8,300 the previous school year. In 1997, when enrollment was higher, the number of exempted kindergartners was 4,318.
At Ocean Charter School in Del Rey, near Marina del Rey, 40% of kindergartners entering school last fall and 58% entering the previous year were exempted from vaccines, the highest rates in the Los Angeles Unified School District.
Three kids on the same block were diagnosed with leukemia last year. That couldn’t happen just by chance, could it? There MUST be something in the environment that caused it (power lines, the chemical plant down the street, asbestos in their school, iPods, Twinkies?). Quick, let’s measure everything we can think of and compare exposures to other blocks and find an explanation.
That may be the common reaction, and it may seem plausible to the general public, but it’s not good science.
I have just read a book that does a great job of elucidating the pitfalls of epidemiologic studies, the problematic interface between science and emotion-laden public concerns, and the way environmental hazards have been hyped far beyond the evidence. Hyping Health Risks: Environmental Hazards in Daily Life and the Science of Epidemiology by Geoffrey C. Kabat.
He covers the uses, strengths and limitations of epidemiology, discusses the pros and cons of different study designs, and explains how to judge whether an association is causal.
Here at Science-Based Medicine we’ve been getting a lot of letters from medical students. This is a good thing and a bad thing. I’m glad people see us a a resource for SBM, but I’m unhappy that medical students: 1) need us; 2) don’t have someone to approach on campus. Let’s explore some of the more subtle ways cult medical practices infiltrate medical education.
In order to give all of their students experience in outpatient medicine, most med schools must reach out to the community. Sure, some med schools have big enough clinics to support an experience for all of their students, but that’s the minority. For their internal medicine, pediatrics, and family medicine rotations, med students often spend time at private doctors’ offices. These offices are minimally vetted, and I’d venture to guess that the vetting does not include checking for non-standard practices. In fact, schools are so desperate for spots, that almost any office will do. It’s good for students to see how medicine is practiced in the “real world” but that real world often involves cult medicine practices. Along the same lines, many practitioners are not up to date on the most recent best practices. I remember a family doc I worked with who used to give huge doses of intramuscular steroids to people for seasonal allergies. This isn’t the best idea, but I was a student. Who was I to tell him how to practice medicine?
We don’t police our colleagues very effectively—we have surrendered that duty largely to the courts. However, if doctors want a medical school affiliation, it seems a small price to allow the school to come in and see if the office practices medicine according to the standard of care. In addition to checking for the most minimal quality standards, it would rule out docs who are offering voodoo in place of medicine.
Early in the history of this blog, I wrote a rather long post expressing my dismay at the infiltration of unscientific “complementary and alternative medicine” (CAM) or “integrative medicine” (IM) modalities into American medical schools. In it, I listed the medical schools that had embraced pseudoscience through having started a CAM/IM program (a list desperately in need of an update). Moreover, we have also complained vociferously here about a clear effort on the part of advocates of faith-based medicine to infiltrate bastions of science-based medicine and to piggyback their agenda onto President Obama’s health care reform initiative in a clear political strategy to slip CAM/IM into any health care reform legislation as a form of “preventative medicine.” It’s all part of a multi-pronged strategy to claim popular and legal legitimacy in the absence of scientific legitimacy. At one point I even despaired because of the apparent success of half physician, half CAM huckster Dr. Andrew Weil at developing a CAM/IM curriculum that would be part of the mandatory training program in several family medicine residencies, while the rest of us watch Senator Tom Harkin try to promote pseudoscience in the halls of the Senate.
However, since one of our newest co-bloggers, medical student Tim Kreider, arrived, I’ve come to appreciate that medical schools and medical school curriculae are ground zero in the battle for science- and evidence-based medicine. Besides the infiltration of non-science-based modalities into the standard curriculum, another technique for making medical students believe that woo is equal to science is the student “campus CAM group” that invites, for example, homeopaths and naturopaths to give talks to medical students, too many of whom are too timid to challenge them on their pseudoscience. However, a reader of a “friend” of mine wrote me an e-mail that truly appalled me. In fact, it appalled not just me, but all of my co-bloggers who read it. It’s from a medical student in an American medical school. It’s not Harvard or a huge famous medical school. However, it is in medical schools like this one where the vast majority of medical students are trained in this country. If the infiltration of CAM/IM into medical schools continues in this way, we’ll have more than just “integrating” woo into the medical school curriculum from day one. We’ll have more tales like this; eventually, no one will find such tales unusual or even unacceptable anymore. The shruggies will no longer even shrug anymore. Such clinics will become simply the way medical students are educated. The following e-mail is de-identified, and I’ve edited it a bit to make as sure as I can that it is not traceable:
The best way to prevent sexually transmitted infections is the proper use of condoms. That being said, it’s not the only way to prevent STI’s. Abstinence is one way, but it involves an amputation of sorts—the removal of a critical human behavior. Another amputation (of sorts) that prevents STIs is circumcision. Male circumcision has been found in several good studies to reduce the rate of HIV transmission, and now a study out of Uganda shows a significant decrease in rates of genital herpes infections (HSV-2), human papilloma virus (HPV) infection (the strains that cause penile, cervical, and anal cancer), but no decrease in syphilis infection.
This study complements the our knowledge on the benefits of circumcision to prevent disease. The authors emphasize that circumcision alone is not sufficient, but may be a useful adjunct to prevent serious STIs. In fact, STI’s tend to travel together, and ulcerative diseases such as herpes increase transmission of HIV.
More than any other time in history, mankind faces a crossroads. One path leads to despair and utter hopelessness. The other, to total extinction. Let us pray we have the wisdom to choose correctly.
~ Woody Allen
No good deed goes unpunished.
The website whatstheharm.net is a depressing recitation of the harm that humans do to themselves and others from participating in various forms of nonsense in the attempt to do good. It my backfire, and instead pain and death result.
I would bet that most practitioners of medical woo are true believers. They do not intend to harm people, and believe they are doing good for their patients. Certainly the consumers of alternative therapies intend to have good benefits from their use of sCAM modalities. Most want to get better, and do not intend to hurt themselves or others.
Unfortunately, actions always have unintended consequences. Sometimes the harm is directly to the patient. Sometimes the harm in indirect, with collateral damage to people or the environment. My hospital system has an extensive recycling program to handle the huge amounts of waste generated by the need to insure that all manner of materials are sterile. Patients in isolation consume large amounts of paper and plastic to keep infection confined. My hospitals actively look for ways to decrease their environmental impact and carbon footprint and still deliver high quality medical care. Legacy Health System, where I work, is an award winning leader recycling medical waste, which is a lot more difficult to dispose of than the pop cans and paper bags in your house. Hopefully the trash in your house is not covered with pus, blood and other potentially hazardous medical waste. We try to be good global citizens.
I wonder if some branches of the alternative medical industrial complex are so environmentally conscious.
I thank everyone for my warm welcome to the SBM community. Although vaccine myth is of particular interest to me, I promise that my posts wont all be vaccine related. There is, unfortunately, much to discuss. In fact I had a difficult time deciding which vaccine-related issue to write about for my inaugural post. In the end I came up with more of an opinion piece, but it’s an issue worth airing. Things in anti-vaccine land may be reaching a dangerous turning point.