No doubt you’ve come across them before, either on the Internet, printed advertisements, or radio and TV ads: Alternative medicine cancer “testimonials.” They are the primary means by which “alternative” therapies for cancer (or just about any other disease) are promoted and the primary “evidence” that is used to “prove” the efficacy of non-evidence-based therapies. There’s no doubt that they sure can sound convincing. Typically, what you will see or hear is a chipper-looking and -sounding person who claims that this treatment “cured” his or her cancer. These testimonials almost always include many or all of these elements: First, the cancer patient receives the diagnosis, after which she is lost and suffering at the hands of “conventional” doctors, who either cannot or do not wish to understand and who cannot do anything for her. Often, this will take the form of the classic alt-med cliche that the patient was “sent home to die.” Then, when all hope seems lost, the patient discovers an alternative medicine “healer” or treatment. It is not infrequently described in quasireligious terms, like a revelation or something that brings the patient out of the darkness and into the light. Naturally, there is resistance from the patient’s doctors, family, and/or friends, who warn against it, with doctors warning of dire consequences if the patient abandons conventional medicine. But the patient, convinced by dubious practitioners, friends, and, of course, previous testimonials, “sees” that the treatment “works” in a way that medical science cannot and survives. Infused with fervor, the patient now wants to spread the word. Often, the patient is now selling the remedy. Perhaps you’ve seen such testimonials or heard them on the radio and thought: “Gee, this sounds great. I wonder if it works.”
The answer is: Almost certainly not.
Part I of this blog† summarized the origin of homeopathy, invented in 1790 by Samuel Christian Hahnemann. It discussed Hahnemann’s first two “homœopathic laws of nature,” similia similibus curantur (like cures like) and the “law of infinitesimals,” and showed that his rationales for each have long been refuted. Hahnemann proclaimed a third doctrine, the “law of psora” ["itch"], said by him to be “the mother of all true chronic diseases except the syphilitic and sycotic.” Oddly, it seems to have been forgotten.
Part II gives Hahnemann the opportunity to explain his assertions more thoroughly, as is his due. It considers those assertions from the vantage point of modernity, as is ours.
“Leave None of them Uncured”
According to Hahnemann, homeopathy is a panacea:
“Now, however, in all careful trials, pure experience, the sole and infallible oracle of the healing art, teaches us that actually that medicine which, in its action on the healthy human body, has demonstrated its power of producing the greatest number of symptoms similar to those observable in the case of disease under treatment, does also, in doses of suitable potency and attenuation, rapidly, radically and permanently remove the totality of the symptoms of this morbid state, that is to say, the whole disease present, and change it into health; and that all medicines cure, without exception, those diseases whose symptoms most nearly resemble their own, and leave none of them uncured.”
How might this happen?
On October 3,4, 2007, a conference at Harvard University School of medicine, the first annual “Fascia Research Conference“ was held, sponsored by a notable group of organizations. Organized by Thomas Findley, MD, Phd, Prof. of Physical Medicine and physiatrist at Veterans Administration Hospital East Orange, New Jersey. It was notable for several reasons, and is of interest to medical objectivists – also for several other reasons. First, the conference was the first research conference devoted solely to the study of fascia (a type of connective tissue) – stated to be a forgotten tissue. Second, it included scientific subjects such as intra-cellular structure and stress changes in fascial cells, but also unscientific ones such as on acupuncture and “Rolfing.”
Belief in the healing power of magnets and magnetic fields has existed since the discovery of magnets several thousand years ago. In the late 18th century, Franz Anton Mesmer, an infamous charlatan, promoted the notion that he could heal with “animal magnetism.” In the 19th century magnetic healers were common – D.D. Palmer was a magnetic healer prior to founding chiropractic. Magnetic devices for everyday aches and pains have been increasingly popular recently, and today they are a multi-billion dollar industry.
Yet the scientific evidence does not, generally, support the use of magnets for specific indications, and the vast majority (if not totality) of claims made for magnetic devices in marketing are either false or unsupported and highly implausible. The media attention given to a recent study of static magnetic fields (SMF) in the treatment of inflammation brings up many important points regarding this disconnect.
A sciencedaily.com headline from January 7th proclaims: “Healing Value Of Magnets Demonstrated In Biomedical Engineering Study.” This headline is extremely misleading, especially the use of the word “healing.” The article is referring to a study by CE Morris and Thomas Skalak(1) published two months ago in the American Journal of Physiology – Acute Exposure to a Moderate Strength Magnetic Field Reduces Edema Formation in Rats. In the sciencedaily article Skalak is quoted as saying:
“We now hope to implement a series of steps, including private investment partners and eventually a major corporate partner, to realize these very widespread applications that will make a positive difference for human health.”
This optimism, however, is premature, and represents a significant problem with many popular therapies, the extrapolation from preliminary pre-clinical studies to clinical applications in humans. But before I look at this new study in more detail I will review some basic concepts for background.
For my first blog entry, I wanted to write about something important, and I couldn’t think of anything more important than a recent book by R. Barker Bausell: Snake Oil Science: The Truth About Complementary and Alternative Medicine. If you want to understand how medical research works, if you want to know what can lead patients and scientists to false conclusions, if you have ever used complementary or alternative medicine or have wondered why others do, if you value evidence over belief, if you care about the truth, you will find a treasure trove of information in this book.
Some of the treatments encompassed under “complementary and alternative medicine” (CAM) have been around for a long time. Before we had science, “CAM” was medicine. Back then, all we had to rely on was testimonials and beliefs. And even today, for most people who believe CAM works, belief is enough. But at some level, the public has now recognized that science matters and people are looking for evidence to support those beliefs. Advocates claim that recent research validates CAM therapies. Does it really? Does the evidence show that any CAM therapy actually works better than placebos? R. Barker Bausell asks that question, does a compellingly thorough investigation, and comes up with a resounding “NO” for an answer.
Bausell is the ideal person to ask such a question. He is a research methodologist: he designs and analyzes research studies for a living. Not only that: he was intimately involved with acupuncture research for the National Center for Complementary and Alternative Medicine (NCCAM). So when he talks about what can go wrong in research and why much of the research on CAM is suspect, he is well worth listening to.
One of the most pernicious medical myths of recent years has been the claim, promulgated by a subgroup of parents of autistic children and facilitated by scientists of dubious repute, that somehow the mercury in the thimerosal (ethyl mercury) preservative used in common childhood vaccines in the U.S. until early 2002 causes autism. Although it had been percolating under the radar of most parents and scientists for several years before, this belief invaded the national zeitgeist in a big way in 2005, beginning with the publication of a book by journalist David Kirby entitled Evidence of Harm: Mercury in Vaccines and the Autism Epidemic: A Medical Controversy. The fires of hysteria were stoked even higher by Robert F. Kennedy, Jr., who published a truly twisted and misleading piece of pseudojournalism and pseudoscience published simultaneously in Rolling Stone and on Salon.com entitled Deadly Immunity. Relying primarily on quote-mining of the transcripts of both a conference held Atlanta by the CDC to discuss the question of whether autism is related to thimerosal in vaccines and an Institute of Medicine report on vaccines while simultaneously misrepresenting the results of two studies by Verstaeten et al to paint a false picture of a government coverup, RFK Jr. almost single-handedly managed to stoke fears that vaccines were causing an “epidemic of autism.”
I say “almost” single-handedly, because, unfortunately, he had help. Relying on the dubious research of a variety of investigators, such as the father-and-son team of Dr. Mark Geier and David Geier, whose prodigious output of badly designed studies emanating from a lab in their home in suburban Maryland, done using a rubberstamp institutional review board stacked with friends and cronies to approve the studies, and published for the most part in non-peer-reviewed journals, activists loudly insisted that mercury in vaccines was the cause of most autism. Others claiming to demonstrate this link include Boyd Haley, a chemist from the University of Kentucky, and a few other vocal scientists and advocates, who claim that autism is, in essence, mercury poisoning. Facilitating the dissemination of this message were reporters such as David Kirby, activists such as Robert F. Kennedy, Jr., and media personalities such as Don Imus. Indeed, some activists claimed that some vaccines were “poisoning” our children, even going so far as show photos of autistic children with the label “mercury-poisoned“ underneath them on placards held aloft at protest rallies. They made quite a splash then, and still do to a lesser extent even today. There’s just one problem.
“Who am I? Why am I here?”
Who could forget that memorable quote from Admiral James Stockdale, candidate for Vice President running with Ross Perot in 1992, during the first Vice Presidential debate? In a way, as the seemingly junior member of the crew of bloggers assembled here at Science-Based Medicine, I feel as though I should be asking that question, although I hope that, in the weeks to come, I won’t end up giving the same impression in comparison to the rest of the august crew here as Admiral Stockdale unfortunately did during his debate with, of all people, Dan Quayle. No, I don’t want to be leading readers to wonder just what on earth Steve Novella was thinking when he invited me to blog here as a weekly regular. It doesn’t matter that I’m an NIH-funded surgical researcher who’s also been funded by the Department of Defense and the American Society of Clinical Oncology. All that says is that I’m pretty good at science and cancer research (or, if you’re more cynical, that I’m really good at persuading study sections that I do worthwhile research). Without a track record comparable to that of my co-bloggers writing about the issues that this blog will highlight, you might ask: Why should I be taken seriously?
“Either homeopathy works or controlled trials don’t!”
—Scottish homeopath David Reilly at the 2001 Harvard Medical School Complementary and Integrative Medicine Conference.
Reilly based that assertion on his own series of four small studies of homeopathic treatments of hay fever, asthma, and allergic rhinitis, the outcomes of which had been inconsistent and largely subjective. (1) Later he explained that small-minded skeptics in “conventional medicine” assume “homeopathy doesn’t work because it can’t work,” a view echoed by conference host Dr. David Eisenberg, then the Director of the Center for Alternative Medicine Research and Education at Harvard Medical School (now of the Osher Center); these comments were met with appreciative laughter from the partisan audience. If such charges were valid, it would indeed be fortunate that Harvard Medical School, several other medical schools, and the National Center for Complementary and Alternative Medicine (NCCAM) are promoting homeopathy, both as a clinical method and as a topic worthy of research.
A recent web feature produced by the New York Times tells the story of Chris Kilham, “The Medicine Hunter.” Specifically it recounts his thoughts on the use of maca, a root native to South America, “said to have energy and libido enhancing properties,” according to the piece. The brief piece reflects the current attitudes popular in the public and promoted by mainstream media reflecting a false dichotomy between medicinal plants and pharmaceuticals. This false dichotomy is extremely counterproductive and ultimately harmful to consumers.
Kilham represents this false dichotomy when he says:
“My goal is to have more people using safe, effective, proven, healthful herbs, and fewer people using toxic, overly expensive, marginally effective, potentially lethal pharmaceutical drugs.”
There are many unwarranted assumptions in this statement. It seems to be implying that herbs are inherently more safe, less toxic, and more healthful than pharmaceuticals. It also assumes that there is a real difference between the two. Therefore Kilham seems to be saying something meaningful when he is actually just reflecting biased assumptions. This is made clear if we simply reverse his statement. Most people, for example, would agree if I said that “My goal is to have more people using safe, effective, proven, healthful pharmaceuticals, and fewer people using toxic, overly expensive, marginally effective, potentially lethal herbs.”
Science-Based Medicine is a new daily science blog dedicated to promoting the highest standards and traditions of science in medicine and health care. The mission of this blog is to scientifically examine medical and health topics of interest to the public. This includes reviewing newly published studies, examining dubious products and claims, providing much needed scientific balance to the often credulous health reporting, and exploring issues related to the regulation of scientific quality in medicine.
The philosophy of this blog, at its core, is simple: Safe and effective health care is critical to to everyone’s quality of life; so much so that it is generally considered a basic human right. The best method for determining which interventions and health products are safe and effective is, without question, good science. Therefore it is in everyone’s best interest for health care to be systematically evaluated by the best science available.
Too often the nature of science itself is misunderstood or misrepresented to the public. Science is not an arcane and privileged discipline. By its very nature it is meant to be transparent and public. Science is nothing more than a systematic and careful use of evidence and logic to evaluate factual claims. And good science possesses certain virtues that are not unique to science but generic to all intellectual endeavors: fairly accounting for all available evidence, using valid and internally consistent logic, using unambiguous concepts and language, proper use of statistics, being quantitatively precise and accurate, and above all being honest.