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Medicine in the Magic Kingdom of Cascadia

When the Pacific NW succeeds from the Union it is to be part of a new country, Cascadia). The capitol would be Portlandia I suppose. Somehow I think not. But when I watch the devolution of health care in Oregon, I think back the Onion (?) when they reported that the United Kingdom was sold to Disney, being renamed as “The United Magic Kingdom.”

That is health care in Oregon due the steady insinuation of Naturopathy and other pseudo-medicine into real health care.

Oregon Health and Pseudo-Science University

Growing up my alma mater was University of Oregon Medical School. Since then it has undergone two name changes. First to Oregon Health Sciences University and then to the current Oregon Health & Sciences University, OHSU. With, it should be noted, an ampersand not an ‘and’.

Perhaps they need one more name change, since they are not always that interested in the Science part of their name.

Some background.

Portland has a trifecta of pseudo-science schools: Naturopathic (National College of Natural Medicine), Chiropractic (University of Western States) and ‘Oriental’ (Oregon College of Oriental Medicine.

Lucky us.

As an aside my kids let me know that the word ‘oriental’ used to describe people from the east, the term I grew up using, is persona non grata. I understand the reasoning. The proper term, they tell me, is asian. So I have a mental cringe every time I see Oregon College of Oriental Medicine.

All three schools are steeped in pseudo-science and pseudo-medicine, removed from known reality. As examples, the naturopathic school teaches homeopathy (and more), the chiropractic school teaches the subluxation complex and the ‘oriental’ (cringe) school teaches acupuncture. Reading the curricula of the schools suggests that there is no pseudo-medicine stone left unturned.

In the 1980’s OHSU received a grant to study low back pain in conjunction with the chiropractic school. As Cindy Lauper noted, Money changes everything.

Why worry about standards, reality, plausibility, and science when there are Benjamin’s to be had. The Oregon Collaborative for Integrative Medicine was born, the OCIM.

The Collaborative was formally established in 2003 as the Oregon Collaborative for Complementary and Alternative Medicine as the result of a National Institutes of Health R25 CAM Education grant awarded to OHSU. UWS, OCOM and NCNM were all subsequently awarded follow-up R25 education grants.

With OHSU and Pacific University joining up with the troika to, among other plans, develop the Medical Education version of the Island of Doctor Moreau , with grotesque and unnatural hybrids, far worse than any hyena-swine or sloth-creature:

Standing beside the traditional MD/PhD or MD/MPH will be the ND/ MD, the MD/DAOM, the ND/DC, the ND/PhD, the DAOM/MPH and countless other combinations to build new vanguards of cross trained clinicians focused on inclusivity and collaboration

It is like the chemistry department at University of Oregon having an alchemy degree, the astronomy department having an astrology degree, and the physics department a degree in the time cube (I may need a new example soon). But for millions of dollars, why not?

Their website mentions that

In 2003, OHSU was awarded a $1.5 million dollar grant to develop, implement, and evaluate a new four-year curriculum for medical students in complementary and alternative medicine.

$1,500,000 is a lot of money.  As best I can tell from talking with medical students, there is no four-year SCAM curriculum. There is one rotation in an Integrative Medicine Clinic that I would fail, being unable to “establish and maintain a climate of mutual respect, dignity, diversity, integrity, honesty, and trust” with any pseudo-medical provider. But that’s me. They have maybe a half dozen publications as a result.

I just think about what we could do with 1.5 million dollars.  I could have an amazing SCAM course with that kind of money.  I wonder, could he apply for an NICCH education grant?

For support to develop and/or implement a program as it relates to a category in one or more of the areas of education, information, training, technical assistance, coordination, or evaluation.

We do that.

That is all I can find so far, but I have more digging to do.  I have yet to figure out how to find the results of an NIH grant and how the money was spent. For that kind of money I would expect one hell of a curriculum, unless they wasted at least 1.5 million dollars in NIH money and have nothing to show for it. Nah.

At least they have other research to show for their efforts, for as it says on their web page

OCIM and our members have a wealth of past and current research.

and they proudly list, what, oh well…

This section of our website is in development, please check back soon to learn about the enormous breadth of research that has been done and continues to be done in integrative medicine and health…

It is true, there has been and continues to be a enormous breadth of research in pseudo-medicine. Most of research, as we know from this website, is poorly done and the high quality studies demonstrate no utility of most the pseudo-medicines promulgated by the OCIM.

I would love to see this wealth of research, although I suspect it may be as comprehensive as the medical school curriculum they have developed, implemented and evaluated.

And now they are proud to announce a Fellowship in Integrative Medicine.

My motto: with you integrate cow pie into apple pie, the cow pie is not improved, the apply pie is made worse.

For $31,000 over two years virtually anyone (MD, ND, DC) can participate in an virtual classroom of topics that, at least to look at their titles, appear to contain nothing that anyone really needs to know to practice medicine.

But perhaps the content free titles in the curriculum are hiding a deep and meaningful substantive medical education.

Given that ND’s, DC’s, dietitians, social workers and psychologists are among those eligible for the program, a comprehensive understanding of modern science-based medicine would appear not to be a requirement.

I also wonder how the Accreditation Council for Graduate Medical Education (ACGME) and Accreditation Council for Continuing Medical Education approve this program.

So OHSU continues down the road to becoming OHPSU.

Spit Take

This was in the local paper: Naturopathic clinic designated as top tier primary care facility. Good thing I was not drinking when I read the headline.

It has, by the way, my favorite picture of acupuncture technique, because not only are there no gloves on the hands of the acupuncturist as her fingers are next to the needle, there is a box of (unused) gloves behind her on the shelves. I use this photo in every acupuncture talk and the audience always responds with disgusted laughter.

But how could a naturopathic clinic be a top tier primary care facility?

Remember, in Oregon, naturopaths are designated in the statues primary care providers. This is like designating pi as equal to 3.14, but it is the law of the land here in Magic Kingdom of Cascadia. It does not matter that their education and training in real medicine are about the same as buying a Fisher-Price Medical Kit Playset and declaring you are a doctor. According to the state, playing doctor makes you a doctor.

So what then is the requirements to become a top tier clinic?

Core Attributes

– Access to care: Patients get the care they need, when they need it.
– Accountability: Recognized clinics are responsible for making sure patients receive the best possible care.
– Comprehensive: Clinics provide patients all the care, information and services they need.
– Continuity: Clinics work with patients and their community to improve patient and population health over time.
– Coordination and integration: Clinics help patients navigate the system to meet their needs in a safe and timely way.
– Patient and family-centered: Clinics recognize that patients are the most important members of the health care team and that they are ultimately responsible for their overall health and wellness.

There is nothing in the core attributes concerning the actual appropriate diagnosis and treatment of diseases. It is all about service and coordination of care, the infrastucture for providing care, not the actual medical care itself.   This is something that medicine has not always been all that good at in the past.

If you go through the standards, there is almost nothing about adhering to science-based medical care and standards.Use homeopathy, acupuncture, energy and water therapy and other fantastical interventions?  Not even relevant to the designation. And so not only can the naturopathic college get a designation, so can A Natural Path, an ND clinic in Seaside Oregon.  Get it?  Naturopath, Natural Path? So clever.

No good deed ever goes unpunished. Just as evidence-based medicine can be misused to make pseudo-medicine appear effective, the goal to provide better medical care can be misused by those with no medical training at all.

As I read the standard, for something as fundamental as childhood vaccinations, clinics do not actually have to give vaccines, they just need to

offer(s) or coordinate(s) recommended age and gender appropriate preventive services based on best available evidence.

Not actually give the vaccine, just offer and coordinate. Although they do have metrics for meeting minimal vaccination standards for children and adults. I will have to investigate this further as well as determine if I can access the submission forms used by the state to qualify the ND clinics.  I have not heard back from the state as I write this.

As far as the designation as a top tier primary care facility it does not matter in the least, as in the case of naturopaths, that the providers have no education or training in real medicine and that their entire paradigm of medical care is rooted in pseudo-science and fantasy. It is almost all about the service provided, not the quality of medicine practiced.

The designation is like restaurant sanitation grades. Important information about the infrastructure of facility but says nothing about the quality of the cooking. And in the case of an ND clinic, it is like getting the Just Like Home Dinner Play Food.

Addendum

I did not want to hijack the thread on Janns post yesterday, but my main response?

Batman would win. Period.

Hijack away.

Posted in: Naturopathy, Politics and Regulation, Public Health

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Battle of the feds: FTC tells FDA to do its job regulating homeopathy

Two institutions duke it out: FTC vs FDA.

Two institutions duke it out: FTC versus FDA.

Last month, the Society for Science-Based Medicine submitted a comment to the Food and Drug Administration (FDA) in response to its request for public comments on the agency’s current regulation (actually, lack of regulation) of homeopathic drugs. As the SFSBM pointed out, the FDA has, without legal authority, exempted homeopathic drugs from the safety and efficacy requirements applicable to other drugs under the Food, Drug and Cosmetic Act (FD&C Act). Lax regulation has resulted in consumer confusion: consumers do not understand homeopathy, how the FDA regulates homeopathic drugs, and the lack of scientific evidence underlying claims made by homeopathic drug companies.

As it turns out, we were in excellent company. The Federal Trade Commission (FTC), the agency charged with preventing fraudulent and deceptive business practices, submitted its own comment to the FDA, making these same points. (The FTC is holding its own workshop on advertising homeopathic drugs later this month. We’ll get to that shortly.)

The FTC’s advertising substantiation policy requires that health-related efficacy claims be supported by competent and reliable scientific evidence. The FDA, despite federal law, does not require evidence of efficacy for homeopathic drugs prior to their being marketed. This creates a potential conflict between the two regulatory schemes, resulting in homeopathic over-the-counter (OTC) “drugs” on the market that both comply with FDA’s policy and violate FTC’s policy. This, says the FTC, can be harmful to consumers and create confusion for advertisers. The FTC “recommends that the FDA reconsider its regulatory framework for homeopathic medicines” and tells the FDA what it can do to remedy the situation. (more…)

Posted in: Clinical Trials, Health Fraud, Homeopathy, Legal, Politics and Regulation

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Helping the Paralyzed Walk


One of our primary goals at SBM is to advocate for high standards of science in medicine. This means that we spend a lot of our time discussing claims and practices that fall short of this standard. This is very useful – exploring exactly why a claim falls short is a great way to understand what the standard should be and why.

An unfortunate consequence of this approach, however, is that many of our articles tend to be negative. We focus on what doesn’t work, on what needs to be fixed, and on why people fail.

But there is a positive side to the story as well that we should not neglect – science is powerful and it works. That is why we are such enthusiastic advocates of science in medicine and why it is so important to get it right. We shy away from overhyping scientific advances in medicine, because the mainstream media does that so well, but every now and then it’s good to acknowledge awesome medical and scientific advances. (more…)

Posted in: Neuroscience/Mental Health

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The Science of Mom: A Science-Based Book about Baby Care

From the author's website: "Shameless use of cute baby to promote book"

From the author’s website: “Shameless use of cute baby to promote book”

When a baby is born, parents are often awed and alarmed to find themselves responsible for this tiny new person, and they desperately want to do their very best to keep their infant safe and healthy. New mothers worry about everything from SIDS to vaccines, from feeding practices to sleep hygiene, and they are bombarded with conflicting advice about caring for their babies. Myths and misinformation abound. Finally someone has written a truly science-based guide to the first year of life: The Science of Mom. The author, Alice Callahan, is a research scientist with a PhD in nutritional biology. When her first child was born, she had a lot of questions, and thanks to her background she knew how to look for reliable answers in the scientific literature. She started writing the Science of Mom blog and eventually turned her findings into a book.

Understanding science

Her first chapter covers the important concepts for understanding how to think about scientific studies:

  • Good science is a process that takes lots of experiments, time, and people.
  • Good science is peer-reviewed.
  • One study on its own isn’t worth much, but scientific consensus is trustworthy.
  • Some studies are more valuable than others (here she covers the various types of study from animal studies through observational studies in humans to RCTs and meta-analyses).
  • Numbers matter (sample sizes).
  • Don’t believe everything you read on the Internet (here she gives some practical tips for evaluating whether a website is reliable).
  • Correlation is not causation (she uses my favorite example of the correlation between autism diagnoses and the sales of organic food).
  • We can’t eliminate risks (but science can quantify the risks and benefits and families can use the information to decide what risks they are personally willing to take).
  • Find smart allies (experts and providers you can trust).
  • Forget about perfection and pay attention to your baby.

(more…)

Posted in: Book & movie reviews, Nutrition, Vaccines

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“Precision medicine”: Hope, hype, or both?

The cost to sequence a whole genome has been plummeting impressively since 2007.

The cost to sequence a whole genome has been plummeting impressively since 2007.

I am fortunate to have become a physician in a time of great scientific progress. Back when I was in college and medical school, the thought that we would one day be able to sequence the human genome (and now sequence hundreds of cancer genomes), to measure the expression of every gene in the genome simultaneously on a single “gene chip,” and to assess the relative abundance of every RNA transcript, coding and noncoding (such as microRNAs) simultaneously through next generation sequencing (NGS) techniques was considered, if not science fiction, so far off in the future as to be unlikely to impact medicine in my career. Yet here I am, mid-career, and all of these are a reality. The cost of rapidly sequencing a genome has plummeted. Basically, the first human genome cost nearly $3 billion to sequence, while recent developments in sequencing technology have brought that cost down to the point where the “$1,000 genome” is within sight, if not already here, as illustrated in the graph above published by the National Human Genome Research Institute. Whether the “$1,000 genome” is truly here or not, the price is down to a few thousand dollars. Compare that to the cost of, for instance, the OncoType DX 21-gene assay for estrogen receptor-positive breast cancer, which costs nearly $4,000 and is paid for by insurance because its results can spare many women from even more expensive chemotherapy.

So, ready or not, genomic medicine is here, whether we know enough or not to interpret the results in individual patients and use it to benefit them, so much so that President Obama announced a $215 million plan for research in genomic mapping and precision medicine known as the Precision Medicine Initiative. Meanwhile, the deeply flawed yet popular 21st Century Cures bill, which passed the House of Representatives, bets heavily on genomic research and precision medicine. As I mentioned when I discussed the bill, it’s not so much the genomic medicine funding that is the major flaw in the bill but rather its underlying assumption that encouraging the FDA to decrease the burden of evidence to approve new drugs and devices will magically lead to an explosion in “21st century cures,” the same old antiregulatory wine in a slightly new bottle. Be that as it may, one way or the other, the federal government is poised to spend lots of money on precision medicine.

Because I’m a cancer doctor, and, if there’s one area in medicine in which precision medicine is being hyped the hardest, it’s hard for me not to think that the sea change that is going on in medicine really hit the national consciousness four years ago. That was when Walter Isaacson’s biography of Steve Jobs revealed that after his cancer had recurred as metastatic disease in 2010. Jobs had consulted with research teams at Stanford, Johns Hopkins, and the Broad Institute to have the genome of his cancer and normal tissue sequenced, one of the first twenty people in the world to have this information. At the time (2010-2011), each genome sequence cost $100,000, which Jobs could easily afford. Scientists and oncologists looked at this information and used it to choose various targeted therapies for Jobs throughout the remainder of his life, and Jobs met with all his doctors and researchers from the three institutions working on the DNA from his cancer at the Four Seasons Hotel in Palo Alto to discuss the genetic signatures found in Jobs’ cancer and how best to target them. Jobs’ case, as we now know, was a failure. However much Jobs’ team tried to stay one step ahead of his cancer, the cancer caught up and passed whatever they could do. (more…)

Posted in: Basic Science, Cancer, Clinical Trials, Science and the Media

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ND Confession, Part II: The Accreditation of Naturopathic “Medical” Education

Editors’ note: Britt Marie Hermies of NaturopathicDiaries.com returns to SBM to continue her series on naturopathy from the point of view of someone who has left that profession. If you missed it, the first post was “ND Confession, Part 1: Clinical training inside and out“. She has also contributed “The Wild West: Tales of a Naturopathic Ethical Review Board“.


Prior to renouncing naturopathic medicine and starting NaturopathicDiaries.com, I knew very little about the accreditation of higher education in the United States. I had the impression that accreditation signified that a program or school had the endorsement of the federal government for quality standards. When I first looked into attending naturopathic programs, I remember learning that they are accredited by the U.S. Department of Education.

For me, and I assume for many others, accreditation of naturopathic doctoral programs stood for a medical education of high quality that delivered career prospects similar to those available to primary care physicians who earn an MD or DO. Accreditation also meant I could take out federally-subsidized loans to pay tuition and cover living expenses. Because the $40,000 annual tuition at naturopathic programs was (and still is) comparable to regular medical school, my perception of the validity of naturopathic education at accredited programs made me feel that I was investing in a secure career.

It wasn’t until I graduated from Bastyr University and had been in private practice for several years that I learned the truth about accreditation. Naturopathic programs are accredited by an organization dominated by naturopaths; this authority has been granted to them by the U.S. Department of Education, and they make up their own standards. Leaders in the naturopathic profession can then use the accreditation status of naturopathic programs to convince the public that naturopathic medicine is safe and effective and convince students that they are matriculating into a bonafide medical school.

(more…)

Posted in: Naturopathy, Politics and Regulation

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(Dys-)Functional Medicine Comes to Dentistry

Now there is some functional dentistry!

Now there is some functional dentistry!

The great philosopher Deepak Chopra wrote: “I do not believe in meaningless coincidences. I believe every coincidence is a message, a clue about a particular facet of our lives that requires our attention.” So when SBM author extraordinaire Jann Bellamy emailed me last week with an article about so-called “Functional Dentistry” with the comment “Blog fodder?”, I looked it over with interest and then promptly filed it away in my brain along with other things that I might get around to doing but probably won’t. The very next day, Dr. Clay Jones – also an SBM bloggist extraordinaire – asked me if I’d mind pinch-hitting and write a blog post for his upcoming Friday morning time slot while he was away on vacation.

Coincidence?

Personally, I find it more plausible that Jann and Clay secretly conspired to have me write this article in order to lure me into a rage spiral, than the notion that The Universe was sending me a message about a particular facet of my life that required my attention. But we are at Point B now, are we not? Regardless of whether the first domino was pushed by The Universe or by Jann and Clay, I suppose it is now incumbent upon me to share with the SBM readership yet another way where pseudo-scientific practices and deceptive branding and marketing tactics have trickled down from medicine into dentistry.

In this blog post, I will review what Functional Medicine (FM) is, what is wrong about it and what is right about it (yes, there are aspects of FM that are legitimate, if not admirable), and how it has infiltrated (some say contaminated) the field of dentistry. I think you’ll find that, when you pull back the curtains, the reality of FM as a “new and improved” medical/dental paradigm is vastly embellished and overstated, and the Great and Powerful Functional Medicine Oz is really just an old geezer pulling the levers of spin and hyperbole and pushing the buttons of pseudo-science. (more…)

Posted in: Dentistry, Science and Medicine

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Is there a natural treatment for tinnitus?

Ear Tone is a supplement claimed to help tinnitus. Does it work?

Ear Tone is a supplement claimed to help tinnitus. Does it work?

“Why do you bother blogging?” asked a colleague. “You take hours of your personal time to write, and you do it for free. You’re not even getting any citations for all that work.” I admit I found the questions a bit surprising. True, you won’t find SBM posts abstracted in PubMed. But I’m writing for an entirely different audience. I blog for the same reason that I became a pharmacist: to help people use medicines more effectively. Practicing as a pharmacist is one way to do that. In that setting, you’re helping one patient at a time. And seeing how your advice and support can enhance someone’s care is tremendously gratifying.

I see blogging as another form of pharmacy practice, hopefully with similar effects. Yes I do get regular hate mail, and the occasional legal threat, but there’s also gratitude for a post that resonated with someone, or helped them make better decisions about their health. When Google searches don’t give answers, I get questions — too many to answer. Today’s post is based on a request for help from someone seeking advice on natural supplements to treat ringing in their ears. They have tinnitus, and they’re frustrated at the limits of what their physician (and medicine) can do. They sent me an advertisement for a supplement called Ear Tone, a natural health product which is advertised (and approved) to provide tinnitus relief. Can natural supplements do what conventional medicine cannot? (more…)

Posted in: Herbs & Supplements

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An Industry of Worthless Acupuncture Studies

Electro-AcupunctureEven more interesting to me than the question of whether or not acupuncture is effective for any particular symptom is the meta-question of how acupuncture proponents have managed to promote a treatment with systematically terrible scientific data. A new study provides a fresh example of this, which I will discuss below.

I think the behavior of acupuncturists reflects the fact that there are subcultures within science, where each community has its own standards, culture, and typical practices. You see this reflected in how they conduct their research and support their claims. Chiropractors, for example, have what is in my opinion a very unscientific culture. Their treatments are not science-based; science is an afterthought cherry-picked to support what is ultimately their philosophy.

The culture of acupuncture

The world of acupuncture has its own culture as well. Within this world there are special, very permissive rules of science that allow acupuncture to work for almost anything. One trend is to look for anything that happens locally in the skin when you stick a needle into it and then declare that a “mechanism for acupuncture.” The rules of the acupuncture culture also allow for a shifting definition of what acupuncture actually is, allowing the definition to conform to whatever the evidence shows. It’s a neat and subtle trick that allows acupuncture proponents to completely subvert the purpose of science.

(more…)

Posted in: Acupuncture

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Taxpayers Fund Scientology Research on Gulf War Veterans

Church_of_Scientology, Fountain Avenue, Los Angeles

The “Hubbard protocol” is Scientology’s religion-based, pseudoscientific “detoxification” treatment used in its Narconon program to treat drug addiction. It was dreamed up by a science fiction writer with no medical training. Now it is being studied as a treatment for veterans suffering from Gulf War illness. Our limited public money for research is being wasted on a study with no scientific merit. Whether or not you consider this a church/state conflict, the study is clearly ill-advised.

The study: $600K worth of sweat

A description of the study is available online in the government’s clinical trials registry. The DOD funded this study to the tune of $633,677. The subjects are veterans with Gulf War illness characterized by persistent memory and concentration problems, headaches, fatigue, and muscle and joint pain. The illness has not been well defined, and its cause has not been determined; but the researchers are working on the assumption that toxins are the cause and that the treatment will relieve symptoms by removing toxins from the body.

The control group will get only “usual care.” The experimental group will get:

A four to six week regimen consisting of daily, supervised, mild-moderate exercise as tolerated for 20 minutes, supervised, intermittent Finnish saunas (at about 140’F) sauna time with breaks and showers, gradually increased as tolerated to approximately 4 hours, dietary supplements including immediate release niacin in gradually increasing doses from 100 mg to a maximum of 5000 mg per day, salt and water, other vitamins, minerals and oils per Hubbard protocol.

(more…)

Posted in: Clinical Trials, Religion

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