September 26, 2002Kimball Atwood, M.D. xxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxx
I have now had time to look into the allegations in your letter of June 14th which, incidentally, I shared with Dr. David Eisenberg and he with several others. I have sought consultation about our exchanges and the gist of my response follows.
Some of your concerns and allegations are very helpful and constructive. Perceptions are particularly important in controversial fields where there is limited objective proof. Your cautions and interpretations in this area have been very useful to us.
Some of what you said is just plain wrong. This includes the allegation the Harvard has “a stake” in the area and therefore would not look into your allegations objectively. Relatedly, Dr. Howard Koh has written us a construction of the events in the Massachusetts Special Commission that is strikingly different from yours. And Dr. Anthony Komoroff has pointed out that many of your comments about the InteliHealth treatment of CAM are now grossly out of date as the material inherited from another provider has been reviewed by HMS faculty and modified. [Indeed, you have referred in other correspondence to modifications you have noticed.] Dr. Komaroff also commented on the misleading way your citation the treatment of homeopathy was disconnected from the rest of the paragraph.
Some of what you said is a matter of taste or interpretation, where even well intentioned people may disagree. In this particular area I have weighed your arguments carefully and, in places, learned from them.
But I think the biggest difference may be in a misperception about what our purposes are. The Council of Academic Deans of Harvard Medical School approved beginning a Division of Research and Education in Complementary and Alternative Therapies with exactly the focus described. Our goal is to do peer-reviewed basic and clinical research on the claimed, but unproven, efficacies of complementary and alternative approaches to therapeutics. The recent scientific sessions and requests for proposal held by the Division are clear testament to this intent. In addition, in common with the Association of American Medical Colleges and most of the allopathic schools of medicine, we intend to teach our students something about CAM and in particular how to assess its claims rigorously. We do not, repeat NOT, have any intention of making our students CAM practitioners. They have enough to do learning what we have always focused on.
Daniel D. Federman, M.D.
cc: David M. Eisenberg, M.D.
Archive for Science and the Media
Welcome back, my friends, to the show that never ends, part II: Generation Rescue, the anti-vaccine propaganda machine, and “Fourteen Studies”
I hadn’t planned on writing about the antivaccine movement again this week, so soon after having had to subject myself to yet another round of Jenny McCarthy on Larry King Live and a truly execrable Generation Rescue “study.” I really hadn’t. For one thing, there’s just so much nonsense laid down by antivaccinationists these days that it’s utterly impossible for one blogger to keep up with it all. I could write about them every single day and still not counter the sheer mass of pseudoscience, misinformation, and general ignorance that antivaccine activists spout each and every day, and because this is Autism Awareness Month lately the misinformation has been coming particularly fast and furiously. Sometimes, however, there arrives a bit of misinformation that is so egregious that it requires some response, regardless of how burned out on the topic I might be; so I guess I’ll just have to suck it up and plunge into the morass again.
The reason is that, in retrospect, I now realize that the Jenny and Jim antivaccine propaganda tour was clearly merely phase I of Generation Rescue’s April public relations offensive. In rapid succession last week, courtesy of J.B. Handley, the founder of Generation Rescue, who in order to have a couple of famous faces fronting his organization has allowed himself to be displaced, so that Generation Rescue has now been “reborn” as Jenny McCarthy and Jim Carrey’s Autism Organization (the better to capitalize on her D-list celebrity yoked to Jim Carrey’s formerly A-list (but rapidly plunging) celebrity), announced Generation Rescue’s latest initiative in a post on its antivaccine blog Age of Autism entitled Fourteen Studies? Only if you never read them.:
HMS Puts the Messenger in its Crosshairs
When, during the fall and winter of 2001-02 I first approached Dean Daniel Federman of the Harvard Medical School (HMS) with evidence that the HMS “CAM” program was promoting pseudomedicine, I gave him some materials that I thought would be adequate to make the case: ‘CAM’ Director David Eisenberg’s dubious funding sources and his failure to disclose them to the Massachusetts Special Commission; the website of the Caregroup/Harvard Medical School Center for Alternative Medicine Research and Education (CAMRE), which urged anonymous websurfers to “consult your local telephone yellow pages” for ‘naturopathic physicians’ and other quacks; the presence on the ultra-PPO American Association for Health Freedom (AAHF) Advisory Board of attorney Michael H. Cohen, the Harvard CAMRE’s “Director of Legal Programs” (at the time, Dr. Federman agreed with me that the mere existence of such a position was curious, if the CAMRE’s purpose was “research and education”); that Dr. Eisenberg and Atty Cohen had contributed to a report to the Massachusetts State Legislature recommending a formal state imprimatur for the practice of pseudomedicine; and other embarrassing findings. A bit later, in March 2002, I sent him a draft of the essay that I posted in Parts I and II of this series.
That material proved not to be adequate, for on March 20, 2002, Dr. Federman sent me the following letter:
I ready to undertake a formal review of the Harvard Medical School’s Division of Research and Education in Complementary and Alternative Medicine, and of its leadership to investigate the charges outlined in your letter of November 4, 2001, subsequent emails, and our meeting of January 22, 2002 in my office. I have read almost all of the voluminous literature you sent me and am writing to ask you to assist our efforts. Specifically, I am asking you to prepare a one to three page summary of the specific portions of the material you sent me that you consider erroneous, duplicitous, misleading, or fraudulent.* I do not feel I should summarize your views. Please be specific and give sources, where you can, in support of your statements.
I am committed to achieving a careful and balanced review of the issues you raise.
Daniel E. Federman, M.D.
* [These are terms that I had used in my communications with Dr. Federman; the only one from which I backed away, after he reacted with considerable alarm, was “fraudulent.”]
That was the first real suggestion that the fix was in. The pertinent literature that I’d sent Dr. Federman did not consist of “my views” or even my words. It consisted of statements copied from CAMRE publications and other public sources. Why did Dr. Federman now seem to be framing the issue as a matter of (my) opinion? Why weren’t the points that I’d already presented and documented (they were specific and I gave sources) sufficient to trigger an independent, formal review? What about the summary that I’d already written in the form of a letter to Harvard Magazine, which Dr. Federman had also read? No matter: I was still confident that he would do the right thing when he saw the totality of the evidence, abundantly and overwhelmingly supporting my contention that the CAMRE and other HMS affiliates were promoting pseudomedicine—dangerously, unethically, and in contrast to their stated purpose.
It was then that I resolved to write the essays that I posted in Parts I, II and III of this series.‡ I also prepared the summary that Dr. Federman had requested, which is reprinted below. In June, 2002, I sent these together with this letter:
In Parts I and II of this series* we saw that from 2000 to 2002, key members of the Harvard Medical School “CAM” program, including the Director, had promoted quackery to the legislature of the Commonwealth of Massachusetts. We also saw other explicit or tacit promotions by Harvard institutions and professors, and embarrassing examples of such promotions on InteliHealth, a consumer health website ostensibly committed to “providing credible information from the most trusted sources, including Harvard Medical School….”
Those points were made in an essay that I sent in the spring of 2002 to Daniel Federman, the Senior Dean for Alumni Relations and Clinical Teaching at Harvard Medical School (HMS). I also sent Dr. Federman a treatise on homeopathy, including several examples of credulous Harvard professors and misrepresentations aimed at students, patients, and the public. Much of the content of that treatise has been covered by the series on homeopathy† with which I began my stint here on SBM, so here I’ll post only the parts relevant to promotions by academic physicians, including those at Harvard. There is a bit of redundancy involving InteliHealth, but please bear with me if you’ve made it this far; the discussion will be meatier than the short summary in Part II.
Welcome back, my friends, to the show that never ends: The Jenny and Jim antivaccine propaganda tour has begun
As hard as it is to believe, 2009 started out very promising from the perspective of actually countering the misinformation of the antivaccine movement. Antivaccine hero Andrew Wakefield, who with the help of the credulous and sensationalistic media started the entire MMR-autism scare in the U.K. a decade ago, was revealed as not just having been in the pocket of trial lawyers suing vaccine manufacturers and having been an incompetent scientist but as a scientific fraud, thanks to the investigative tenacity of Brian Deer. Thanks to Wakfield, the measles, once declared conquered in the U.K. in the mid-1990s, has come roaring back to the point where it has been declared endemic again by the ealth Protection Agency (HPA), the public health body of England and Wales. This was rapidly followed by the rejection by the Special Masters of the Vaccine Court of the claims of all the test cases in the Autism Omnibus case. It was a one-two body blow to the antivaccine movement.
Unfortunately, the antivaccine movement is nothing if not resilient. After all, the science has consistently been against each of its favorite claims, namely that the mercury in the thimerosal used as a preservative in vaccines or that the MMR vaccine causes autism. They simply move the goalposts and pivoted effortlessly to much harder to falsify ideas, such as blaming “toxins” in vaccines or proclaiming that our current vaccine schedule is “too many too soon.” After scientific setback after scientific setback that have revealed the antivaccine movement to be nothing more than the 2009 equivalent of creationists or the flat Earth movement, why would it matter to them that Andrew Wakefield has been thoroughly discredited and their signature legal action, the Autism Omnibus, has gone donw in flames? It doesn’t. Certainly it didn’t stop David Kirby from duping Keith Olbermann into chastising Brian Deer for nonexistent conflicts of interest; a group proclaiming loudly “We Support Dr. Andrew Wakefield” with a petition; David Kirby, Generation Rescue, and Robert F. Kennedy, Jr. from trying to distract attention from the defeat of the antivaccine movement in the Autism Omnibus ruling; or Andrew Wakefield himself from “complaining” to a press board about Brian Deer’s alleged misbehavior and errors. After all, science doesn’t matter to the antivaccine movement.
David Gorski suggested I expand on a comment I left recently on one of his November posts. His subject was the then new documentary movie, “A Beautiful Truth.“ “Truth” is about the Gerson method – the dietary deprivation cum coffee enema cancer treatment developed by Dr. Max Gerson, a refugeee from Germany I the 1930s. His daughter, Charlotte now runs the Gerson Institute in Tijuana, Mexico. Gerson is one of the models for the Gonzales method recently reviewed by Kim Atwood.
I had previously referred to the movie in a prior post (1) (but in a different context. Here I’ll explore the movie from a different angle – with its partners, propaganda documentaries.
David called my attention to “Truth” plus another by the same producer – with trailers on You Tube. When I watched the trailers last year I saw myself interviewed briefly, but could not recall being filmed, or even identify where the scene took place. I had to email Steve Barrett, also in the movie, who reminded me about filmmaker Steve Kroschel’s visits 2-3 years before, although neither did he have strong memory of the interview.
Jenny McCarthy, regular readers of SBM know, has been a frequent target of criticism here. The reasons, of course, are very simple. She has become the most famous public face of the antivaccine movement, releasing a book every year or so since 2007 about how her son Evan has been “cured” of autism through the dubious biomedical treatments she’s given him and how it was vaccines that supposedly caused her son’s autism. Most recently, she’s releasing a paean to antivaccine views and autism quackery entitled Healing and Preventing Autism: A Complete Guide, co-authored by Dr. Jerry Kartzinel. Dr. Kartzinel, some may recall, wrote the foreword to Jenny McCarthy’s very first paean to autism quackery back in 2007 and was properly lambasted by Autism Diva and Kevin Leitch for writing
Autism, as I see it, steals the soul from a child; then, if allowed, relentlessly sucks life’s marrow out of the family members, one by one…”
Sometimes, in order to appreciate just how wrong antivaccinationist are, it’s best to let them speak in their own words. Nowhere recently have I seen a better example of this than in an interview with Jenny McCarthy published on the TIME Magazine website. In it, along with the usual invocation of the “toxins gambit” and appeals to anecdotal evidence over science, Jenny reveals that she clearly thinks it’s regrettable but acceptable that infectious diseases will return because of the efforts of her and her fellow antivaccine activists:
Three kids on the same block were diagnosed with leukemia last year. That couldn’t happen just by chance, could it? There MUST be something in the environment that caused it (power lines, the chemical plant down the street, asbestos in their school, iPods, Twinkies?). Quick, let’s measure everything we can think of and compare exposures to other blocks and find an explanation.
That may be the common reaction, and it may seem plausible to the general public, but it’s not good science.
I have just read a book that does a great job of elucidating the pitfalls of epidemiologic studies, the problematic interface between science and emotion-laden public concerns, and the way environmental hazards have been hyped far beyond the evidence. Hyping Health Risks: Environmental Hazards in Daily Life and the Science of Epidemiology by Geoffrey C. Kabat.
He covers the uses, strengths and limitations of epidemiology, discusses the pros and cons of different study designs, and explains how to judge whether an association is causal.
I used to have a high opinion of PBS. They ran excellent programs like Nova and Masterpiece Theatre and I felt I could count on finding good programming when I tuned into my local PBS channel. No more.
It was bad enough when they started featuring Deepak Chopra, self-help programs, and “create your own reality” New Age philosophy, but at least it was obvious what those programs were about. What is really frightening is that now they are running programs for fringe medical claims and they are allowing viewers to believe that they are hearing cutting edge science.
Neurologist Robert Burton has written excellent articles for salon.com pointing out the questionable science presented by doctors Daniel Amen and Mark Hyman in their PBS programs. Please click on the links and read what he wrote. These programs are being shown during fundraising drives as if they were examples of the best PBS has to offer. (more…)
Last week, two events took place in Washington that ought to inspire trepidation in the minds of all who value ethical, rational, science-based medicine and ethical, rational, biomedical research. One was the Senate Panel titled Integrative Care: A Pathway to a Healthier Nation, previously discussed by my fellow bloggers David Gorski, Peter Lipson, and Steve Novella, and also by the indefatigable Orac (here and here); the other was the “Summit on Integrative Medicine and the Health of the Public” convened by the Institute of Medicine (IOM) and paid for by the Bravewell Collaborative, previewed six weeks ago by fellow blogger Wally Sampson. This post will make a few additional comments about those meetings.
Senator Harkin and the Scientific Method
Thanks to Dr. Lipson, I didn’t have to listen to the Senate Panel video to find out that Senator Tom Harkin (D-Iowa) made this statement of disappointment regarding his own creation, the National Center for Complementary and Alternative Medicine (NCCAM):
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)
Are scientists at the NIH really too afraid of Harkin to explain to him how science works? Apparently so. Otherwise Harkin might learn that his statement is more wrong-headed than it would be for one of us to complain that the Supreme Court ought to assume that a defendant is guilty until proven innocent, rather than the other way around. In scientific inquiry, for those who don’t know, good experimental design is always directed at disproving a hypothesis, even one that pleases its investigator. The rest of Harkin’s sentiment—“seeking out and approving”—is incoherent.
The Selling of ‘Integrative Medicine': Snyderman Trumps Weil
Spin doctors shilling for ‘integrative medicine,’ which the NCCAM defines as “combining treatments from conventional medicine and CAM,” appear to have now decided that subtler language is more likely to sell the product. We’ve previously seen an example offered by ‘integrative’ Mad Man Andrew Weil: