What a wonderful world it would be if cancer patients could extend their survival time by mobilizing their immune systems by eating the right foods, practicing yoga, and venting their emotions in a support group. The idea that patients can enlist their immune systems to fight the progression of cancer is deeply entrenched in psychosomatic medicine and the imagination of the lay public, and evidence to the contrary has been sometimes bitterly resisted. Of course, cancer patients can use psychological techniques to relieve stress or find emotional relief in support groups and thereby improve the quality of their lives. But the prospect of being able to improve the quality of life pales in comparison to the promise of being able actually to extend life.
The hope that psychosocial intervention extends lives attracts philanthropic contributions to cancer centers and justifies research programs to determine just how psychological processes affect cancer. It is a lot easier to obtain funding if we promise to slow progression of cancer than if we merely claim to offer patients solace and support or to be study ways to reduce stress and improve emotional well-being.
No mechanism by which the mind can alter the course of cancer has been convincingly demonstrated. But the jury was still out until the late 2000s, when well-resourced, carefully designed trials — with survival as the primary endpoint — repeatedly failed to show that psychological interventions were effective. My colleagues and I asked at the 2006 European Health Psychology Conference whether we could “Bury the Idea…” that psychotherapy could extend lives of cancer patients, and this was followed by our systematic review of the available data, “The Conflict Between Hope and Evidence.” Investigators who had undertaken ambitious, well-designed trials to test the efficacy of psychosocial interventions echoed with “Letting Go of Hope” and “Time to Move on.” For some of us, to make claims in earshot of cancer patients that we could extend their lives with psychotherapy was perpetuating a cruel hoax.
One of the points I’ve tried to emphasize through my contributions to Science-Based Medicine is that every treatment decision requires an evaluation of risks and benefits. No treatment is without some sort of risk. And a decision to decline treatment has its own risks. One of the challenges that I confront regularly as a pharmacist is helping patients understand a medication’s expected long-term benefits against the risks and side effects of treatment. This dialogue is most challenging with symptomless conditions like high blood pressure, where patients face the prospect of immediate side effects against the potential for long-term benefit. One’s willingness to accept side effects is influenced, in part, by and understanding of, and belief in, the overall goals of therapy. Side effects from blood-pressure medications can be unpleasant. But weighed against the reduced risk of catastrophic events like strokes, drug therapy may be more acceptable. Willingness to accept these tradeoffs varies dramatically by disease, and are strongly influenced by patient-specific factors. In general, the more serious the illness, the greater the willingness to accept the risks of treatment.
As I’ve described before, consumers may have completely different risk perspectives when it comes to drug therapies and (so-called) complementary and alternative medicine (CAM). For some, there is a clear delineation between the two: drugs are artificial, harsh, and dangerous. Supplements, herbs and anything deemed “alternative”, however, are natural, safe, and effective. When we talk about drugs, we use scientific terms – discussing the probability of effectiveness or harm, and describing both. With CAM, no tentativeness or balance may be used. Specific treatment claims may not be backed up by any supporting evidence at all. On several occasions patients with serious medical conditions have told me that they are refusing all drug treatments, describing them as ineffective or too toxic. Many are attracted to the the simple promises of CAM, instead. Now I’m not arguing that drug treatment is always necessary for ever illness. For some conditions where lifestyle changes can obviate the need for drug treatments, declining treatment this may be a reasonable approach – it’s a kick in the pants to improve one’s lifestyle. Saying “no” may also be reasonable where the benefits from treatment are expected to be modest, yet the adverse effects from treatments are substantial. These scenarios are not uncommon in the palliative care setting. But in some circumstances, there’s a clear medical requirement for drug treatment – yet treatment is declined. This approach is particularly frustrating in situations where patients face very serious illnesses that are potentially curable. This week is the World Cancer Congress in Montreal and on Monday there were calls for patients to beware of fake cancer cures, ranging from laetrile, to coffee enemas, to juicing, and mistletoe. What are the consequences of using alternative treatments, instead of science-based care, for cancer? There are several studies and a recent publication that can help answer that question. (more…)
Popper (1959/2002) defined a scientifically true effect as that “which can be regularly reproduced by anyone who carries out the appropriate experiment in the way prescribed.”
The paper is the latest replication of Daryl Bem’s 2011 series of 9 experiments in which he claimed consistent evidence for a precognitive effect, or the ability of future events to influence the present. The studies were published in The Journal of Personality and Social Psychology, a prestigious psychology journal. All of the studies followed a similar format, reversing the usually direction of standard psychology experiments to determine if future events can affect past performance.
In the 9th study, for example, subjects were given a list of words in sequence on a computer screen. They were then asked to recall as many of the words as possible. Following that they were given two practice sessions with half of the word chosen by the computer at random. The results were then analyzed to see if practicing the words improved the subject’s recall for those words in the past. Bem found that they did, with the largest effect size of any of the 9 studies.
Dr. Andrew Weil has teamed with Innate Response Formulas to develop a series of seminars and a line of products for “seasonally appropriate integrative strategies.” Seasonal Therapeutics is a system for adjusting diet supplement recommendations according to the season of the year. To kick off the program, a one-day seminar was presented by Weil’s colleague Tierona Low Dog in Boston on August 25, 2012. It was approved for 8 CEU credits for DCs and NDs through the University of Bridgeport, a school that has ties to Sun Myung Moon’s Unification Church and offers degrees in naturopathy, chiropractic, and acupuncture. It cost $129 to attend the seminar, but participants were given a product credit of $129 so they could apply their newfound knowledge by buying Innate products.
In a video, Dr. Weil acknowledges that the best nutrition is obtained through diet but says it is essential to take supplements as insurance against gaps in the diet. He recommends Innate Response products because they are formulated with whole foods and contain accessory compounds that have health benefits. They are claimed to be “food, not chemicals” and “potent healing solutions.” They describe their seminars as “research based programs.”
A series of seminar programs will address seasonal issues:
Autumn: Season of Harvest: focuses on liver and GI
Winter: Season of Reflection: focuses on immune and mood
Spring: Season of Renewal: focuses on purification and allergy
Summer: Season of Vitality: focuses on cardio and joint health. (more…)
There is something in molecular biology and genetics known as the “central dogma.” I must admit, I’ve always hated the use of the word “dogma” associated with science, but no less a luminary than Francis Crick first stated it in 1958, and it has been restated over the years in various ways. Perhaps my favorite version of the central dogma was succinctly stated by Marshall Nirenberg, who said, “DNA makes RNA makes protein,” which about sums up all of molecular biology in five words. Or at least it did until the last ten or twenty years, when we’ve been finding exceptions to this dogma.
I don’t want to dwell on the central dogma. As I’ve said, I loathe the use of the term “dogma” to describe anything in science, although a discussion of the central dogma and its exceptions might make for a decent post one day. What brought the central dogma to mind is a series of articles I saw recently in ONCOLOGY: Perspectives on Best Practices that let me to ponder the question: What is the “central dogma” of “alternative medicine”? I realize that alt-med is an unwieldy gmish of ideas that range from the semi-plausible but unproven to the completely ridiculous (i.e., homeopathy or reiki), but after reading these articles and thinking about it, I do believe that there is in actuality a “central dogma” of alternative medicine. I also believe that it is entirely appropriate to call it a “dogma” in this situation, because it is far more a matter of faith than it is of science. Moreover, the more that quackademic medicine infiltrates academic medicine, the more this “central dogma” has infiltrated academic medicine with it. Indeed, as you will see, when this central dogma is questioned, even by someone sympathetic to “complementary and alternative medicine” (CAM; i.e., “complementing” medicine with quackery) or “integrative medicine” (i.e., the “integration” of pseudoscientific medicine with medicine). (more…)
Last month at JREF’s The Amaz!ng Meeting in Las Vegas, 3 SBM bloggers along with Rachael Dunlop of Australia participated in a panel on “The Truth About Alternative Medicine.” The video is now available on Youtube. It’s a chance for readers to see Steven Novella, David Gorski and Harriet Hall and hear them speak instead of just reading what they write.
I do not want to get all angsty and omphaloskeptic, but I have been thinking more of late about the purpose of the blog and my role in it. Blogs,and the people who write them, are ephemeral. It takes a unique personality and commitment to churn out these essays and commit them to the ether. Especially since Michelson and Morley.
I have never given much thought as to who our readers are, at least as a composite. I read most of the comments on every entry and have certainly developed a mental picture of some of our regular commenters, although I suspect I probably do not have even the gender correct most of the time. The commenters represent a tiny fraction of the regular readers and an even smaller fraction of occasional readers. It occurs to me I haven’t a clue who the real audience of this blog is.
I write first for my own education and entertainment, then for the slightly bored and overwhelmed medicine resident, since that is who I spend most of my time educating at work. Someone educated with an understanding of basic medicine but has more important things on their mind than a need for a detailed understanding of why homeopathy is complete nonsense. I doubt the majority of my readers are health care workers and I suspect continuing medical education is not a major part of the blog.
I never considered SBM to be a consumer protection group, but this week my wife showed me a half page advertisement in the local paper, and I realized that not only was the advertisement a good topic for blogging, but consumer protection is a fundamental result of this blog. There really is no site on the interweb that looks at both SCAM and real medicine with quite the same skeptical eye. Here is the headline:
A Special Wellness Report
New Medicine Based On An 88- Year Old Theory By Albert Einstein Can Help Almost Everyone Who Is Sick Or Injured! (more…)
[o]nce considered archaic and obsolete, Oriental Medicine has greatly benefited from the postmodern attitudes towards science and knowledge. This is because postmodernists consider the ‘truth’ as being relative to one’s viewpoint or stance. They do not see science as a superior process of acquiring knowledge, but as a ‘belief system,’ a ‘language game,’ which does not give more access to truth than other conceptual constructs.
This “postmodern fallacy,” he continued,
has allowed the return of mass professional delusions under the label of Chinese, Oriental or Asian Medicine. As an unfortunate byproduct, dangerous and outdated therapies have been legitimized, and quacks and charlatans can overtly defraud those who cannot distinguish scientific medicine from lore and fantasy.
There is probably no better example of this “unfortunate byproduct” than the state acupuncture and oriental medicine practice acts. These laws have indeed legitimized dangerous and outdated therapies, allowing quacks and charlatans to defraud the public.
Be careful what you wish for. In the last few decades purveyors of dubious medical treatments and products have been trying to go mainstream, and they have had some unfortunate success. They asked for serious scientific investigation into their claims – and they got it. They asked to be treated like real medicine (but not really, they only want the trappings of legitimacy, not the substance), and when they actually are treated with the standards similar to science-based medicine, they cry foul.
The response of the fake-medicine lobby is not to alter their claims to fit the evidence, or to carry out better studies, or to clean up their act when problems are brought to their attention – but to attack their critics.
Homeopathy is perhaps the best example of this behavior. Homeopathy’s biggest marketing advantage is that most people don’t know what it really is. They think it’s “natural” medicine or herbs. That is why, during homeopathy awareness week, I was happy enough to oblige. I want people to know exactly what homeopathy is – sugar pills. They are placebos on which the equivalent of a magical ritual has been cast. Active ingredients, which themselves are as fanciful as fairy dust, are diluted into non-existence.
The issue of PSA screening has been in the news lately. For instance, an article in USA Todayreported the latest recommendations of the US Preventive Services Task Force (USPSTF): doctors should no longer offer the PSA screening test to healthy men, because the associated risks are greater than the benefits. The story was accurate and explained the reasons for that recommendation. The comments on the article were almost uniformly negative. Readers rejected the scientific evidence and recounted stories of how PSA screening saved their lives.
It’s not surprising that the public fails to understand the issue. It’s complicated and it’s counterintuitive. We know screening detects cancers in an early stage when they are more amenable to treatment. Common sense tells us if there is a cancer present, it’s good to know about it and treat it. Unfortunately, common sense is wrong. Large numbers of men are being harmed by over-diagnosis and unnecessary treatment, and surgery may not offer any advantage over watchful waiting. (more…)