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Why would medical schools associate with quackery? Or, How we did it.

Why would medical schools risk association with quackery?

…a question from a Washington Post reporter in 1998.

The following hypothetical answer composed in response was never sent. It awaited a proper forum. Could this be one?

Well, Jeff, quackery is a pejorative term. Some time ago we recognized that words raise emotions and mental pictures. We recognized the cognitive dissonance raised by them, so we tried to eliminate quackery. We recognized the cognitive dissonance raised when one discusses acupuncture, chiropractic, homeopathy, and healing at a distance as if they were quackery when we made claims. For a century, most people just could not allow for the possibility that these things really work.

So over time we recognized that we had to do something about our language. That would be the first step in enabling the thought revolution that is upon us, and changing the paradigm in medicine and science. We simply changed the adjectives, and gave alternate names to the methods, added a few phrases to eliminate negative reactions, and shifted the negative terms to descriptions of the Medical Establishment (and, note the caps in that one.)
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Posted in: Basic Science, Politics and Regulation, Science and the Media

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Politics and Science at the HHS

When politics and science collide, shenanigans are likely to ensue. Politics is often antithetical to science because the former is about persuasion and value judgments while the latter is about objectivity and transparency. Science cannot function properly under the yoke of political ideology.

The infiltration of unscientific and anti-scientific practices and ideas into mainstream medicine is primarily an act of politics and ideology trumping science. The latest example of this comes from the Department of Health and Human Services (HHS) who put out a press release on June 16th declaring that: “HHS Secretary and Chinese Minister of Health Sign Memorandum of Understanding on Traditional Chinese Medicine Research.” The press release states:

“Many Americans incorporate alternative medical practices into their personal health care and are interested in the potential of a variety of traditional Chinese medicine approaches,” Secretary Leavitt said. “This project will advance our understanding of when and how to appropriately integrate traditional Chinese medicine with Western medical approaches to improve the health of the American and Chinese people.”

This statement is so common among the political apologists for unscientific medicine that is has become almost a cliche. The first claim in Secretary Leavitt’s statement is that “Many Americans incorporate alternative medical practices into their personal health care…” This is misleading and irrelevant. The primary problem is with the use of the term “alternative medicine” without providing any kind of definition. This is a false category because the modalities that are generally included in so-called CAM do not necessarily have anything in common except for the fact that they lack adequate scientific justification to be considered part of mainstream medicine. That is, except for those treatments that CAM proponents sneak into this category to misleadingly inflate its apparent size and impact – like exercise, nutrition, physical therapy, etc. These modalities can be scientific (depending upon how they are applied) and have no place under the CAM umbrella.

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Posted in: Politics and Regulation, Public Health, Science and Medicine

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Death By Medicine

Critics of “conventional” medicine delight in pointing out how much harm it causes. Carolyn Dean, Gary Null, and others have written extensively about “death by medicine.” A typical statement (from Mercola.com) says:

A definitive review and close reading of medical peer-review journals, and government health statistics shows that American medicine frequently causes more harm than good. The number of people having in-hospital, adverse drug reactions (ADR) to prescribed medicine is 2.2 million. Dr. Richard Besser, of the CDC, in 1995, said the number of unnecessary antibiotics prescribed annually for viral infections was 20 million. Dr. Besser, in 2003, now refers to tens of millions of unnecessary antibiotics. The number of unnecessary medical and surgical procedures performed annually is 7.5 million. The number of people exposed to unnecessary hospitalization annually is 8.9 million. The total number of iatrogenic deaths shown in the following table is 783,936. It’s evident that the American medical system is the leading cause of death and injury in the United States. The 2001 heart disease annual death rate is 699,697; the annual cancer death rate, 553,251.

To show what’s wrong with this reasoning, let’s substitute “food” for “medicine.” (more…)

Posted in: Science and Medicine

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The Journal of American Physicians and Surgeons: Ideology trumps science-based medicine

I approach this week’s topic with a bit of trepidation, even though I’ve been meaning to discuss it ever since this blog started. Over the weekend, I decided I had put it off long enough.

Why, you might ask, would I approach this topic with trepidation? A reasonable question, and I will give what I hope to be a reasonable answer. For one thing, this topic forces me to drift to areas more political than I normally like and is likely to provoke some angry reactions. More importantly, though, I’m about to discuss a medical organization that is steeped in an utterly toxic brew of bad science and extreme ideology. So what? you might ask. Well, there are some fairly prominent physicians that belong to this organization, including Ron Paul, among others, and you never know who in my own place of employment or referral base might also belong. For all I know, one of my bosses might belong. I sincerely hope this isn’t the case (or if it is they just don’t know about the organization’s extreme views), but you never know, and what I’m about to write is going to be harsh indeed because articles from the journal published by this organization are often cited by cranks and pseudoscientists. Sometimes they even make their way into the mainstream press as though they were legitimate scientific studies. Make no mistake, though, when it comes to medical science, this organization deserves every harsh word that I am about to write because it is a major booster of antivaccinationism, HIV/AIDS denialism, and the now discredited hypothesis that abortion causes breast cancer, while on its pages it regularly attacks the very concept of evidence-based medicine and peer-review. That it is an organization of physicians is all the more appalling.

The group to which I refer is the Association of American Physicians and Surgeons (AAPS), and its journal is the Journal of American Physicians and Surgeons (abbreviated JPANDS, because “JAPS” has some rather obvious negative connotations). It is not an exaggeration to say that the AAPS, through its journal JPANDS, is waging a war on science- and evidence-based medicine in the name of its politics.
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Posted in: Medical Academia, Politics and Regulation, Science and Medicine, Science and the Media, Vaccines

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Another State Promotes the Pseudoscientific Cult that is “Naturopathic Medicine.” Part 2

The “Safety of Naturopathic Treatment”

In their nationwide effort to convince lawmakers to pronounce them primary care physicians, “educated” naturopaths have repeatedly claimed that their “natural” treatments are “safer and gentler” than those offered by medical doctors. The Alliance Legislative Workbook, a website that for several years provided strategies and “talking points” for ND-activists seeking state licensure, made this assertion in 2001:

Malpractice insurance rates [for licensed NDs] are generally less than $4000.00 per year, indicating the safety of naturopathic treatment as assessed by insurance companies. Master Insurance Trust reports that of the naturopathic physicians for whom MIT provides liability insurance, there have been only four incidents reported to the company for follow-up. However, nothing has been paid in either settlements or judgements on any of these items. “While this pooling of physicians is much too small to base actuarial considerations, this claims experience is clearly superior.” (Jeffrey D. Brunken, Program Manager, MIT, Letter dated May 21, 1990.)

Jury Verdicts Northwest, a legal database which records court cases in Washington and Oregon, the area of the country with the largest number of naturopathic physicians, shows no judgments for malpractice against N.D.s since the database was started in 1983. One in five M.D.s is sued each year in the US (AMA).

Why is malpractice so much lower among naturopathic physicians?

Naturopathic methods are less likely to cause injury than orthodox methods. Prudent dietary and lifestyle changes, for instance, are unlikely to cause harm. Naturopathic physicians by philosophy and training use the least invasive means to treat and prevent disease. This results in less injury to patients. Naturopathic physicians also have excellent diagnostic and referral skills. There is no significant history of complaints against naturopathic physicians resulting from a missed diagnoses, the most common cause for suits in a general practice. From insurance data, it appears that naturopathic physicians as a group know the limits of their methods and refer patients to other practitioners or specialists when appropriate.

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Posted in: Health Fraud, Politics and Regulation, Science and Medicine

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The FDA Cracks Down on Fake Cancer Cures

The Food and Drug Administration (FDA), the agency that regulates the drug industry in the US, put out a press release yesterday warning “Individuals and Firms to Stop Selling Fake Cancer ‘Cures’.” The press release reports:

“Although promotions of bogus cancer ‘cures’ have always been a problem, the Internet has provided a mechanism for them to flourish,” said Margaret O’K. Glavin, the FDA’s associate commissioner for regulatory affairs. “These warning letters are an important step to ensure that consumers do not become the victim of false ‘cures’ that may cause greater harm to their health.”

The FDA therefore recognizes that this is a serious problem, and that is good. They also acknowledge that the problem of “bogus cancer cures” is a longstanding one, not a new or recent problem, but the reason they are taking action now is because the internet is significantly increasing the reach of these fake cures.

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Posted in: Cancer, Health Fraud, Politics and Regulation

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Not Treating – A Neglected Option

One of the criticisms of modern medicine is that doctors prescribe too many pills. That’s true. Patients and doctors sometimes get caught up in a mutual misunderstanding. The patient assumes that he needs a prescription, and the doctor assumes that the patient wants a prescription. But sometimes patients don’t either need or want a prescription.

I’ll use myself as an illustration. I get occasional episodes of funny, blurry spots in my visual field that gradually expand to a sparkling zigzag pattern and go away after 20 minutes. They are typical scintillating scotomas, the aura that precedes some migraines. I am lucky because I never get the headache. My doctor said we could try to prevent my symptoms with the same medications we use to prevent migraine, but there was no need to treat them from a medical standpoint. Nothing bad would happen if we didn’t treat. I told her I didn’t want them treated. They are a minor annoyance; I can carry on with my normal activities, even reading, throughout the episodes, and I have no desire to take pills with potential side effects and with the cost and the hassle of remembering when to take them.

If it had been a typical patient and a typical doctor, the sequence of events might have been very different. The patient might have been more frightened by the strange phenomenon than I was. (I thought the weird tricks my brain could play on me were fascinating and fun to watch, not scary.) The patient might have desperately wanted those threatening symptoms to go away without understanding how insignificant and non-threatening they really were. The doctor might have assumed the patient wanted them to go away. The pills might have been offered and accepted with little thought. (more…)

Posted in: Science and Medicine

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Why the latest Geier & Geier paper is not evidence that mercury in vaccines causes autism

Several people have been sending me either links to this paper or even the paper itself:

Young HA, Geier DA, Geier MR. (2008). Thimerosal exposure in infants and neurodevelopmental disorders: An assessment of computerized medical records in the Vaccine Safety Datalink. J Neurol Sci. 2008 May 14 [Epub ahead of print]. (Full text here.)

A few have asked me whether I was planning on deconstructing this study, given that antivaccinationists have apparently been promoting it as “evidence” that it really, truly, and honestly was the mercury in vaccines after all that caused autism. In actuality, I really didn’t feel the need to bother to do a full deconstruction because a new blogger called EpiWonk did a three part take-down that eviscerated this latest bit of “science” from Geier père et fils so thoroughly and with a much greater knowledge of epidemiology than I could ever muster, that I saw no need. Add to that a four-part takedown on the Pathophilia blog, and there was really no need for me to write a detailed deconstruction of my own. Unfortunately, since this study appears to be rearing its ugly head again and again in the blogosphere, I think it’s worth directing you to these discussions. I had been meaning to to this anyway, but had gotten side-tracked by numerous other topics. To make up for my lapse, here we go:

  1. New Study on Thimerosal and Neurodevelopmental Disorders: I. Scientific Fraud or Just Playing with Data?
  2. New Study on Thimerosal and Neurodevelopmental Disorders: II. What Happened to Control for Confounding?
  3. New Study on Thimerosal and Neurodevelopmental Disorders: III. Group-Level Units of Analysis and the Ecological Fallacy

Meanwhile, the Pathophilia blog also has a multi-part deconstruction of the latest Geier study from a different viewpoint:

  1. IRB Approval of Geier Autism Study: Yes or No?
  2. I’ve Been Sucked Into the Thimerosal-Autism-Geier Vortex
  3. Young-Geier Autism Study: What the—? (Part 1)
  4. Young-Geier Autism Study: What the—? (Part 2)
  5. Young-Geier Autism Study: What the—? (Part 3)
  6. Young-Geier Autism Study: What the—? (Part 4)

Ow! That’s gonna leave a mark!
Enjoy! And the next time an antivaccinationist points to this particular study, send ‘em over to see EpiWonk and Pathophilia.

Posted in: Public Health, Science and Medicine, Science and the Media, Vaccines

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The media versus the frontiers of medicine and surgery

A couple of months ago, one of my esteemed co-bloggers, Wally Sampson, wrote an excellent article about borderlines in research in conventional medicine. Such borderlines are particularly common in my area of expertise (cancer, which is also Dr. Sampson’s area of expertise) because there are so many cancers for which we do not as yet have reliably curative therapies. Patients faced with unresectable pancreatic cancer (as, for example, Patrick Swayze and the President of the American Medical Association have been diagnosed with) or metastatic solid cancers against which medicine generally has mostly palliative treatments, it is very tempting to take a “what have we got to lose?” attitude and pursue increasingly aggressive therapies that may actually shorten what little life a patient has left, all too often making that little bit of life more miserable than it had to be. As Dr. Sampson described in great detail, this sort of push to the borderlines and beyond led to the widespread acceptance during the 1990s of bone marrow transplantation as a treatment for advanced or inflammatory breast cancer based on uncontrolled studies that suggested a benefit. Later studies demonstrated no survival benefit (and possibly even a detriment), and that, or so it would seem, was that.

Except it wasn’t. Indeed, the other point that Dr. Sampson made was how the press covers these sorts of issues. He discussed a story that appeared in the San Francisco Chronicle about a young woman with advanced breast cancer who underwent stem cell transplantation for stage IV breast cancer at M.D. Anderson Cancer Center and was embroiled in a fight with Kaiser Permanente, her insurer, which refused to cover the treatment because it was deemed experimental and was at the time covering the cost of radiation therapy but refusing to cover the costs of extra followup scans required by the M.D. Anderson protocol. The article, not surprisingly, covered the story from the angle of the brave young cancer victim being further victimized by a greedy insurance company. And Evanthia Pappas is no doubt brave, and no one could read about her plight without rooting for her to beat the odds. The problem is that no consideration was given to just how unlikely this incredibly expensive treatment was to benefit her and whether it was even ethical to be doing such a study in which the patient bore over $200,000 of the cost for a treatment that was indeed experimental and being studied in an uncontrolled clinical trial. There are some very thorny medical, ethical, and financial issues there indeed.

Perhaps the reason Dr. Sampson’s post resonated with me was because it reminded me of a story that was extensively discussed last year, so much so that I saved the link to it. The story (Cancer Patients, Lost in a Maze of Uneven Care) appeared on the front page of the New York Times last summer. The article in question starts out by telling a truly sad story about a 35 year-old woman who, after giving birth, was diagnosed with Stage IV colon cancer as the human interest “hook” with which to represent what is described as a systemic problem with cancer care in this country:
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Posted in: Cancer, Medical Ethics, Science and Medicine, Science and the Media, Surgical Procedures

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Another State Promotes the Pseudoscientific Cult that is “Naturopathic Medicine.” Part 1

Minnesota has recently become the 15th state in the U.S. to formally endorse the claims of a tiny group of naturopaths who portray themselves as physicians.* The bill , like the popular-media “CAM” reports that Steve Novella criticized on Wednesday, merely parrots what these naturopaths claim about themselves. It reveals no attempt to investigate or to judge the tenets of the field. The following excerpts present false assertions as though they were facts. I’ve underlined some of the more obvious examples:

“Naturopathic medicine” means a system of primary health care for the prevention, assessment, and treatment of human health conditions, injuries, and diseases

“Naturopathic physical medicine” includes, but is not limited to, the therapeutic use of the physical agents of air, water, heat, cold, sound, light, and electromagnetic nonionizing radiation and the physical modalities of electrotherapy, diathermy, ultraviolet light, hydrotherapy, massage, stretching, colon hydrotherapy, frequency specific microcurrent, electrical muscle stimulation, transcutaneous electrical nerve stimulation, and therapeutic exercise.

The practice of naturopathic medicine includes, but is not limited to, the following services: (1) ordering, administering, prescribing, or dispensing for preventive and therapeutic purposes: food, extracts of food, nutraceuticals, vitamins, minerals, amino acids, enzymes, botanicals and their extracts, botanical medicines, herbal remedies, homeopathic medicines, dietary supplements and nonprescription drugs as defined by the federal Food, Drug, and Cosmetic Act, glandulars, protomorphogens, lifestyle counseling, hypnotherapy, biofeedback, dietary therapy, electrotherapy, galvanic therapy, oxygen, therapeutic devices, barrier devices for contraception, and minor office procedures, including obtaining specimens to assess and treat disease

Unlike the Minnesota leglislators, I have substantial knowledge of the tenets and practices of “naturopathic physicians,” and I am capable of judging those tenets according to standards of reason, science, and modern, science-based medicine. Beginning with my stint on the Massachusetts Special Commission on Complementary and Alternative Medical Practitioners 6-8 years ago, I have spent years listening to “NDs,” reading their literature, and writing about them. I described a bit of my experience on that Commission in a post on Science-Based Medicine several weeks ago. I have continued to observe NDs’ cult-like behavior since then, and have seen no indication that they have begun to awaken from their collective, pseudoscientific stupor.

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Posted in: Health Fraud, Politics and Regulation, Vaccines

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