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Tom Harkin’s War on Science (or, “meet the new boss…”)

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.

Addendum

Thanks to a commenter, we learn that the third largest contributor to Harkin’s campaign fund is Herbalife International.

Posted in: Politics and Regulation, Science and Medicine

Leave a Comment (20) ↓

20 thoughts on “Tom Harkin’s War on Science (or, “meet the new boss…”)

  1. mdiehl says:

    This is Harkin. Remember he and Orrin Hatch were the primary authors of DSHEA. The problem is that he believes CAM helped him and that the rest of us are being deprived of its “benefits.”

  2. pmoran says:

    “There is no alternative medicine; only medicine that has been proved to work, and medicine that has not. ”

    Well, we could try and define the problem out of existence, but the truth of this statement depends upon what you mean by “work” and the clinical effect that you have in mind. There is little doubt that if someone is in pain, anything given as treatment will help at least some, at least temporarily, as placebo.

    The “work” divide is blurry in other ways. The Cochrane Collaboration operates with a meaning of “works” which is difficult to argue against with the laity (since it is how we choose drugs) but which allows acupuncture clinically relevant benefits for certain conditions.

  3. pmoran says:

    I am not trying to be difficult or provocative (well, only a bit). There are excellent arguments against Integrative medicine but the usual sensitivities of the “defenders of science” makes them likely to overlook those in favor of assertions that have little impact on the laity and that derive from an overly romanticised view of how medicine works and a selective approach to what the science says, or allows.

    I think the best argument against “integrative medicine for all” is that it would cost a mint, through its need for an enormous additional investment in expensive medical expertise, while having an only erratic and so far unquantifiable effect upon illness.

    There is no good evidence that it can effectively replace any currently available medical services, so that most IM use will be additive and used by the “worried well” and those with truly incurable chronic illnesses. These patients are already very high consumers of medical services and, however deserving they may be, they should not be drawing more from the resource pool ahead of those having a better established relationship of benefit to cost. There are always plenty of these in any medical system.

    Re preventive medicine: the main role of the doctor here should be in the evidence-based screening for certain medical problems. There should be no need for expensively trained medical practitioners to be offering individual tuition in lifestyle measures that can be written on the back of an envelope, and taught in the home, schools and on TV.

    Certainly people should be free to seek out additional unproven treatments, if they wish, but not at taxpayer expense, and with some level of consumer protection against the sharks that infest CAM waters.

  4. Harriet Hall says:

    Even if you accepted the myths of integrative medicine, how would that mesh with Senator Baucus’s recent proposal in the Senate Finance Committee about reducing costs by rewarding and penalizing doctors to make their care decisions more uniformly evidence-based?

    Do these Senators ever talk to each other?

  5. mandydax says:

    I have tried in the past to give Senator Harkin the benefit of the doubt and overlook this ridiculousness for all the good things he has actually done for my state and country, but this is really the final straw. I did write a response to him, and I hope it does make him think before it goes down the memory-hole.

    Senator, I have endured enough irrationality from you. Assuming I am still an Iowan in November of 2014, and you are still pushing the unproven modalities of so-called Complementary and Alternative Medicine, I will not be voting for you. Your incredulity that actual scientific studies of such things as homeopathy, acupuncture, and energy healing have revealed that they are nothing more than elaborate placebos and your insistence that these types of “alternative medicine” be integrated into science- and evidence-based medicine are really beyond the pale.

    You say that “[I]t is time to adopt an integrative approach that takes advantage of the very best scientifically based medicines and therapies, whether conventional or alternative.” If “alternative” medicine is scientifically proven to be effective, it then becomes simply medicine.

    Anecdotes do not data make. The human mind is far too susceptible to be biased, to see patterns that are not really there, and to take personal experience as evidence. The use of double-blinding in controlled trials helps to eliminate this effect and let us see what is really going on. If the trials at the NCCAM have found the alternative therapies lacking, it is probably because those therapies don’t work.

    It’s considered unethical in medicine to give a patient a placebo without their consent, and yet many alternative therapies that have been shown over and over in controlled and blinded conditions that they are no more effective than a sugar pill would be are allowed to be given as if they were real medicine.

    If you truly want to help reform America’s health care system to make it work better for more people, you must make sure that real, effective treatments are available even to those without coverage and that nonsensical wishful thinking doesn’t prevent someone from seeking a treatment that might actually be able to save their life.

    I encourage you to read through the posts on sciencebasedmedicine.org, a blog by actual medical doctors that has many posts explaining why CAM doesn’t work. You may not like what you see, but it is based in reality and not wishful thinking.

    Yours in reason,
    Miranda Richards

  6. Dr Benway says:

    “Do these Senators ever talk to each other?”

    LOL. You may be forgetting that conventional MDs are rich arseholes brainwashed by BigPharma. They are also on the take. This is why we must keep them all on a short leash.

    CAM practitioners, on the other hand, really care about how people feel. They are warm and sweet like puppies. They just want to love you until you feel better, and they need our support!

  7. Fifi says:

    Dr Benway – “They just want to love you until you feel better, and they need our support!”

    Sounds like a good reason to legalize and subsidize prostitution to me. Free hugs and blowjobs all round! ;-)

  8. apgaylard says:

    Poor old Kuhn. I know that his Structure of Scientific Revolutions suffers from inconsistancies and contradictions (eloquently pointed out by Sokal and Bricmont, among others) but his work doesn’t deserve to be treated the way it is by the sCAMmers.

    Here is a choice quote:

    “[...] scientific development is, like biological, a unidirectional and irreversible process. Later scientific theories are better than earlier ones [...] That is not a relativist’s position, and displays the sense in which I am a convinced believer in scientific progress.” (SSR 1996 Ed. p.206

    He did, admittedly, demur from descriptions of scientific progress in terms of convergence to “reality” or “truth” – but not in terms of utility.

    In short there is nothing in Kuhn to suggest anything remotely like the regressive “paradigm shift” CAM proponants bleat on about. For Kuhn science progresses from its past to a future state which is more useful than what has gone before.

    For Kuhn theory choices are about “good reasons“; classic scientific “good reasons” at that. The truth of the matter is, of course, that the spurious “paradigm shift” advocated by CAM fans has no “good reasons” going for it – it is, as your piece shows, about returning to debunked concepts.

    (Final mini-rant; in 1969 he backed away from the use of the term ‘paradigm’ to represent the body of knowledge subject to change – prefering the broader “disciplinary matrix”; not that any of the CAM people ever notice – but that’s another story.)

  9. LindaRosaRN says:

    I’ve only listened to half the testimony so far. It was disheartening to see the tactic of characterizing “alternative medicine” as “preventative.” “Diet” and “exercise” were emphasized, but surely only for effect. There was only the occasional mention of acupuncture or liver detoxification.

    Weil was asked about examples and then talked about how breathing has been overlooked and how two 30-second sessions of breathing could do wonders. His other example was — and I’m not sure of the name — “laughter yoga.” Surely this simple-minded response gave some Congressmen pause.

    But then there was Oz’s discussion of his Oprah-promoted project “HealthCorps” (http://www.healthcorps.net/) currently operating in seven states. College grads specially trained to be alter-Oz’s are released on high schools and communities to promote healthy living, see that sidewalks are built (“people won’t walk if there aren’t sidewalks”), make sure grocery stores sell whole grains and specific vegetables important for liver detoxing.

    Has anyone spoken to this Congressional committee on behalf of science and medicine? Is anyone representing reason?

  10. Danio says:

    “Diet” and “exercise” were emphasized, but surely only for effect.

    Right, because MDs never, ever make recommendations about diet or exercise. Ergo, they are clearly ‘alternative’ modalities. *snort*

  11. Karl Withakay says:

    RE: “One of the purposes of this center was to investigate and validate alternative approaches”

    My analogy: “One of the purposes of the courts system is to try and find guilty people charged with crimes.”

    See anything wrong in common with both those statements?

  12. hatch_xanadu says:

    Mm. What’s been worrying me about folks who bemoan the “loss of science” from a layman’s point of view—and that includes our president—is that they haven’t realized that science has a much more formidable enemy than radical fundamentalists. Sites like this are essential in helping the public to understand that what really mucks up the system is pseudoscience in science’s clothing. I hope that “returning science to its rightful place” will not come to mean “validating anything that sounds sciencey because we like sciencey better than religiony”.

  13. Jurjen S. says:

    As a European who immigrated to the US six years ago, I can think of a few interpretations of Mehmet Oz’s claim that “Americans are twice as sick as Europeans as a people” (if I overlook the fact that Europeans are by no means a single people; hell, you’re lucky if you can get the of any given European country to agree that they’re one “people”) that might be halfway plausible, but unfortunately, in none of those instances would an increased availability of “alternative” health provide an answer.

    Europeans–certainly western Europeans–typically work shorter hours than Americans, and have shorter commutes (at least in terms of distance). They also get more paid sick leave, which might mean they’re less likely to come into the workplace while suffering from a communicable disease. On the other hand, both European work and living spaces are significantly more cramped than American ones (which is part of why those commutes are shorter); in most jobs I’ve had in Europe, having a cubicle would be a major step up in workplace privacy. So maybe as far as communicability of diseases and general stress of living are concerned, all that’s a wash, and perhaps the most firm statement that can be made is that Europeans are less reliant on (and/or able to afford), and therefore spend less time in, cars than Americans do.

    I should note that I moved from the western Netherlands to Washington state, and maybe if I’d moved from rural Poland to New York City, my experience would have been different, but I definitely gained a lot of weight when the local supermarket became too far to walk (or at least, walk back carrying several bags of shopping). And my waistline has definitely widened as a result. But to alleviate that problem, I don’t need an “alternative” health care practitioner, I need an urban planner!

    And as Danio mentioned above, it’s not like your regular GP doesn’t tell you to get more exercise, watch what you eat, quit smoking, cut down on your drinking, all that good stuff. There’s a bit from some stand-up comedian my wife likes to quote that goes:

    I’ve been feeling a little run down lately. I’d go see my doctor, but I already know what he’d say: “stop doing heroin.” Sheesh, what a broken record that guy is.
    And that kind of sums it up. It’s not like every surgeon-general since C. Everett Koop at the latest (and probably several of his predecessors) haven’t been telling us that kind of thing for decades; what added value are we going to get being told the same thing by some sCAM artist who never even saw the inside of a medical school?

  14. MikeC says:

    Pardon me, but I have heard comments like

    “The African Maasai eat a diet high in animal protein (meat, milk and blood from their cows) – yet they have low blood cholesterol levels and low rates of heart disease. Among the Eskimos (who ate an animal-based, very high protein, high fat diet) heart disease was practically unknown.”

    before but have not come across any references. Could you provide some?

    Sorry if I sound challenging, I enjoy eating meat and diary, but I am not sure if such exceptions lend much weight to the diet counterargument. Especially since most of us are not svelte hunter-gathers.

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