Respectful Insolence

I feel bad.

I realize that I’ve been completely neglecting my Academic Woo Aggregator. You remember my Academic Woo Aggregator, don’t you? It was my attempt to compile a near-definitive list of academic medical centers that had “integrated” woo into their divisions or departments of “integrative medicine” (i.e., departments of academic-sounding quackery). Perusing it, I now realize that it’s been over five months since I did a significant update to it. You just know that, given the rate of infiltration of unscientific medical practices into medical academia as seemingly respectable treatment modalities that there must be at least several new additions to this role of shame. Alas, even today, having been shamed myself by the realization of my failure to keep the list updated, I’m not going to do the full update and revamping that the Woo Aggregator cries out for. However, that doesn’t mean I can’t do a piecemeal addition here and there. That doesn’t mean I can’t point out new additions to the Woo Aggregator as they pop up, even if it takes me a while to find the time to give it the facelift it needs.

It doesn’t mean I can’t call out hospitals like Beth Israel when they fall into woo, especially when they do it in a big way for cancer patients.

The first thing to know about this degeneration of a once great academic powerhouse is that, as is the case for many centers of “complementary and alternative medicine” (CAM) or of “integrative medicine” (IM), when looking for the reason why physicians ostensibly dedicated to scientific medicine would embrace this woo, look for the financial reason. In this case, the financial incentive comes from Donna Karan, founder of the famous DKNY line of clothing. In search of her dollars, Beth Israel has turned over an entire cancer treatment floor to woo:

Medical advances sometimes happen in strange ways. Someone finds a fungus in dirty lab dishes and — eureka! — penicillin is born. Now a premier Manhattan hospital is turning a cancer-treatment floor over to a world-famous fashion designer in the hope that serendipity, science and intuition will strike again.

A foundation run by Donna Karan, creator of the “seven easy pieces” philosophy of women’s wardrobes and founder of the much-imitated DKNY line of clothing, has donated $850,000 for a yearlong experiment combining Eastern and Western healing methods at Beth Israel Medical Center. Instead of just letting a celebrated donor adopt a hospital wing, renovate it and have her name embossed on a plaque, the Karan-Beth Israel project will have a celebrated donor turn a hospital into a testing ground for a trendy, medically controversial notion: that yoga, meditation and aromatherapy can enhance regimens of chemotherapy and radiation.

Whatever happened to the days when a wealthy donor would be happy just to have her name on a building or on a floor? I guess they never truly existed. However, it’s truly depressing to see a former academic powerhouse accommodate such wishes just because they’re trendy, because a wealthy donor is willing to fund them, and because, no doubt, hospital administrators perceive it as good publicity and a draw for credulous patients. I wish I could view this as merely a cynical ploy to add a spoon full of woo to make the real scientific medicine go down easier, but somehow I don’t think that’s the case. I also really, really hate it when I see the same old false dichotomy of “Eastern” versus “Western” medicine. There is no such thing as “Eastern” or “Western” medicine. As blog bud PalMD put it:

I’ll stipulate that by “Eastern and Western healing methods” they mean credulous Americans’ impression of what is done in “the East” vs. science-based medicine as it is practiced around the world (the Eastern and Western bits).

What is “Eastern” medicine and what Americans think “Eastern” medicine is are often related only by coincidence.

There’s an old saying, though, that’s so famous and overused that it’s become a cliché, and that’s that the road to Hell is paved with good intentions. Donna Karan hopes that her new “Urban Zen” center will help patients deal with the side effects of chemotherapy. There’s no doubt that, depending on the regimen, chemotherapy can cause very unpleasant side effects, and the alleviation of those side effects is an active area of research in scientific medicine. Here’s what the program will involve:

Fifteen yoga teachers will be sent to Beth Israel’s ninth-floor cancer ward starting in January to work with nonterminal patients, and nurses will be trained in relaxation techniques. Their salaries, as well as a cosmetic overhaul of the ward, are being paid for by Ms. Karan’s Urban Zen Foundation, created after her husband and business partner, Stephan Weiss, 62, died of lung cancer in 2001.

While other hospitals in New York and across the country have dabbled in yoga, the new Beth Israel project is broader, better financed and more integrated into the medical protocol, and because of Ms. Karan’s concern that it might be dismissed as touchy-feely nonsense, it includes a research component. Ms. Karan hopes to prove that the Urban Zen regime can reduce classic symptoms of cancer and its treatment, like pain, nausea and anxiety (thereby cutting hospital stays and costs) and serve as a model for replication elsewhere.

As is the case with virtually all such efforts, this is about proselytization. Donna Karan is a believer, and she is looking for evidence to support her belief in order to justify further proselytizing to other hospitals. It’s all very much like a religion, so much so that we’re hearing the usual excuses that that evil reductionistic “Western” medicine can’t adequately study whether yoga can do what is claimed for it:

But Dr. Benjamin Kligler, the research director in integrative family medicine for the Beth Israel-affiliated Continuum Center for Health and Healing and the research project’s principal investigator, acknowledged that the experiment of yoga teachers and their interaction with patients did not lend itself to the random, double-blind placebo trials favored in the medical world.

“The truth is, from a very traditional research perspective, that’s a problem,” Dr. Kligler conceded, adding that it might be time for the medical establishment to consider a new research model for what he called “lifestyle interventions.”

Poppycock. Even though a randomized, double-blind, placebo-controlled trial can’t be done in a classical sense, but that’s a convenient excuse by woo-meisters for not doin gthe most rigorous studies possible. For example, when a study of Tai Chi as an immune booster was done, the study itself was not really a study of Tai Chi but rather a study of mild exercise versus no exercise in the elderly–with predictable results. Of course, the positive results from that trial were attributed to the woo, rather than to mild, low impact exercise, which, when stripped of all its “Eastern” mysticism, is all that Tai Chi really is. The problem was, the Tai Chi study had no control group in which patients underwent another form of mild, low impact exercise without all the “spiritual” trappings to see if that had a similar effect.

I’m expecting to see the same sort of thing here.

You see, it’s not unreasonable to hypothesize that flexibility exercise might make people undergoing chemotherapy feel better through whatever mechanism, be it distraction or a physiological effect of physical activity. However, this particular form of flexibility exercise, yoga, is overlaid with all sorts of “Eastern” mysticism that credulous CAM aficionados love so dearly. In fact, the “problem” that Dr. Kligler laments about testing yoga for this indication are really not that big a problem. True, blinding is impossible, but we surgeons do unblinded randomized experiments in surgery all the time. (It’s not really practical to blind surgeons to the surgical procedure performed, nor is a sham surgery control group usually feasible, after all.) It’s a bit more difficult to get usable scientific data from clinical trials under such circumstances, but by no means anywhere near impossible. Certainly, it’s not so difficult that we should consider jettisoning current clinical trial methodology, as Dr. Kligler seems to imply that we should.

Of course, where there’s one form of woo, there’s other woo. After all, it’s highly doubtful that Donna Karan would try to sell her yoga program to an institution not likely to be receptive to her woo, and, boy, oh, boy is Beth Israel open to woo. Just get a load of its Continuum Center for Health & Healing. Just peruse its webpage, and it’s a veritable cornucopia of woo and unscientific medical modalities. It’s all there. There’s leech therapy for osteoarthritis, reiki, traditional indigenous healing therapies, acupuncture, even that woo of woo, that quackery to rule all quackeries, homeopathy:

As a pediatrician Dr. Stern finds that homeopathic medicines, which are safe and efficacious, are particularly well suited for the care of children’s common ailments. In her practice Dr. Stern uses homeopathy not only to treat acute problems such as upper respiratory infections and acute ear infections but also to treat more chronic conditions. For children suffering from conditions such as asthma, recurring ear infections, eczema and behavioral problems homeopathy has helped reduce or eliminate daily doses of antibiotics and steroids which are often required for symptomatic control.

Such quackery has no place in an academic medical center–or any medical center, for that matter. Worse, this quackery is being administered to children. Homeopathy is water. Period. Diluting a substance does not render it more potent, nor does shaking it. Period. There is no plausible physiological mechanism by which homoepathy could work, and homeopathy goes against well-established science. Period. Barring incredibly compelling evidence for its efficacy in non-self-limited diseases, there is no reason to suspect that whatever effects are attributed to homeopathy are due to anything more than the placebo effect, regression to the mean, the expectation effect, confirmation bias, or a combination thereof. Period. Yet this woo is being offered at Beth Israel as though it’s on par with scientific medicine–to Beth Israel’s shame. Worse, its being promoted by true believers. Don’t believe me? Then get a load of this detailed and credulously positive description of homeopathy. I just about spit up my drink when I saw Samuel Hahnemann’s homeopathic provings as “meticulously executed experiments” and indulged in appeals to ancient knowledge:

Although Hahnemann was the first to clearly formulate the law of similars and first began to use its principals in a systematic way, he clearly states that a number of people before him had very similar ideas. The “Law of Similars” has a very rich historical basis. Hippocrates (VI century, B.C.) wrote: “through the like, disease is produced, and through the application of the like it is cured”. Celsus and Paracelsus are known to have used the Law of Similars in their practice. The Delphic Oracle proclaimed:” That which makes sick shall heal”. In one of the ancient Jewish writings, called Mekilta, we read: “Man does not heal with the same thing with which he wounds, but he wounds with a knife and heals with a plaster. The Holy One, blessed be He, however is not so, but He heals with the very same thing with which he smites.” Modern medicine uses this principle daily. The “father” of immunology , Dr. Emil Adolph von Behring, wrote about the origins of immunology: “By what technical term could we more appropriately speak of this influence than by Hahnemann’s word “homeopathy”? Desensitization techniques used by conventional allergologists utilize very small doses of allergens to stop a pathological response in the patient.

If ancient knowledge is so great, I always ask whether believers in these ancient modalities would like to go back to the medical systems that existed thousands, or even 200 years ago (the time of Samuel Hahnemann) and see how well it worked compared to today’s scientific medicine. Right on cue after appeals to ancient knowledge are also appeals to popularity:

In England, Australia, New Zealand, India, Russia, Brazil and many other countries homeopathy is recognized as a valid mode of treatment. In the United Kingdom, around 42% of physicians refer patients to homeopathic practitioners, and homeopathic training is the most popular post-graduate training program. In France, approximately 36% of the public and 32% of the physicians use homeopathic remedies. Moscow, Russia, has a homeopathic hospital with a large homeopathic outpatient clinic and many homeopathic pharmacies with many people using various homeopathic preparations daily. India has approximately 125 four- and five-year homeopathic medical colleges with over 100,000 homeopathic doctors practicing around the country.

If you really want to throw up (homeopathically, of course), read another homeopathy article entitled Homeopathy — How it works & when to use it. Its deconstruction is left as an exercise for the reader. I know you guys can handle such a task just fine. While you’re at it, feel free to take on the other woo on the Continuum website. Suffice it to say it’s–shall we say?–a “target-rich environment.”

Of course, no true floor of woo would be complete without real “integration” plus feng shui:

“A lot of other hospitals have integrative medicine, but it’s kind of stuck away in the basement,” said Dr. Merrell, who, not coincidentally, is Ms. Karan’s internist. “People like to think it’s not there.” Starting in November, the cancer ward will be renovated by Ms. Karan, the architect David Fratianne and Alex Stark, a feng shui master. The dull beige walls and green linoleum tile floors will be replaced with bamboo wallpaper and cork floors. Nooks and crannies now used for brown-bag lunches and naps and crammed with a desultory selection of dusty books will be turned into yoga, prayer and meditation retreats for patients, their families and nurses.

As I said before, this is more religion–excuse me, “spirituality”–not science. And, true to most “alternative” medicine, it relies on testimonials. In this case, it’s the story of Lynn Kohlman, a photographer, model and DKNY fashion director who inspired Donna Karan when she developed cancer. In fact, a quote by Karan is most revealing as to the true motivation for the Urban Zen center:

She [Kohlman] intensified her yoga. “She asked for it in the hospital,” said Ms. Karan, who practices yoga daily. “She needed it, she wanted it.

“This works,” Ms. Karan insisted. “Now we have to prove it in the clinical setting.”

That’s exactly the problem. Karan believes that yoga works (although one can’t help but note that it failed to save her friend), and she’s looking for evidence to support her belief, not to see if her belief stands up to experimental testing that could falsify it. That’s one key difference between science and pseudoscience. Given Karan’s attitude, think about this: If the results of the “clinical trials’ being carried out at Beth Israel fail to bear out her belief, how long do you think her generosity will continue? CAM boosters frequently criticize trials of “conventional” pharmaceuticals because of perceived conflicts of interest due to the funding source. That cuts both ways. Don’t think that doctors running the “studies” of yoga at Urban Zen don’t know what their wealthy patron hopes that they will find. Of course, they appear to be true believers as well; so they want to find it too.

Don’t get me wrong. I’m not opposed to using yoga because it makes patients feel better. That’s not what this is about, however, no matter how much Donna Karan and the academic woo-meisters at Beth Israel try to argue otherwise. I wish it were, but it’s not. No, in reality it’s about the rejection of science in favor of “spirituality,” the embrace of testimonial evidence over scientific evidence, and the abandonment of science and reason in medicine–or, even worse, their subversion to serve the beliefs of the people promoting these modalities.

Comments

  1. #1 Joseph C.
    October 31, 2008

    15 yoga teachers? Why not 15 nurses? Oh, because this isn’t really about helping anyone, but rather stroking the ego of a deeply cynical New Ager.

  2. #2 nanio
    October 31, 2008

    Regarding your second to last paragraph. Everyone who runs any sort of clinical trial is aware of what trial sponsors want – to get whatever pharmaceutical or device they’re hoping to sell approved, or to be able to make claims that differentiate their products from the competition. The desire to have a specific outcome is is not remotely unique to yoga-woo and Donna Karan. So unless she’s managing the CRFs and executing the analysis, her stated biases are immaterial to the trial outcome.

  3. #3 The Perky Skeptic
    October 31, 2008

    I think your post has refuted every woo to comment on PalMD’s article! :D Nice job.

  4. #4 I am so Wise
    October 31, 2008

    Nice to see hospitals are joining the ranks of short sighted businesses. See, it’s profitable now to include various forms of woo as a options because they’re cheaper to provider, increase profits, and keep the customer happy. However, in the long run, this will lead to the public to conclude, much as they did in the 1800s, that modern medicine is little more than a sect on par with homoeopathy and the rest of the bogus stuff. Then anyone will be able to treat anyone, for anything, and then hospitals will lose big.

  5. #5 akibare
    October 31, 2008

    Why do I have a sneaking suspicion that lots of fake-Japanese decor and strange brush-style fonts might be involved in the design?

    I think PalMD hits the nail on the head with the quote
    “credulous Americans’ impression of what is done in “the East” vs. science-based medicine as it is practiced around the world (the Eastern and Western bits).”

    Yoga is the only part of it that seemed it MIGHT be useful, but yes, just for the fact that it’s exercise. Near me there are a variety of yoga places varying in woo-scale, on the low end there are places with no spirituality but just “hey, here’s some good low-impact exercise for various parts of your body that don’t require any fancy equipment, pick a body part and sign up.”

    That is certainly a different thing from “medical treatment for cancer” however…

  6. #6 D. C. Sessions
    October 31, 2008

    Whenever someone tells me about the efficacy of homeopathy now, I invite them to meet some mosquitos in Seattle. You know, the ones carrying plasmodium falciparum in the vaccine experiment there.

    If homeopathy is as great as they say, they should have no problem with demonstrating it to us themselves, right?

  7. #7 Sarah Supernova
    October 31, 2008

    Are you so ignorant to think that extra, tender, loving and holistic care to a patient won’t help them? Are you truly so ignorant to think that the physical body exists without the spirit?

    This hospital is not saying “let’s do yoga instead of chemo.” They are saying “let’s blend the both.” Let’s help all sick patients get the best care that treats their sense of love, beauty and spirit AS WELL AS their physical cells, bones and muscles. It’s all integrated.

    Even if yoga does not save a cancer patient’s life, it can help them find an emotional balance that will help them pass through the door of death more peacefully and without fear. I can personally attest that yoga has not only helped me physically, but also emotionally. I didn’t need pills to solve emotional “issues,” but rather discipline, breathing and confidence in my body’s ability and connection to spirit.

    Don’t be such materialists. The world is grander than you can imagine.

  8. #8 D. C. Sessions
    October 31, 2008

    Are you truly so ignorant to think that the physical body exists without the spirit?

    I’m open to testing the hypothesis. Perhaps you could suggest an experimental protocol to settle the question?

  9. #9 Koray
    October 31, 2008

    I am as materialist as my insurers. I can personally attest that not doing yoga helped me not only physically, but also emotionally.

    “Breathing” methods are so 90s. I am now into controlled eye-brow raising.

  10. #10 Rogue Epidemiologist
    October 31, 2008

    Speaking of Academic Woo, I was at the APHA conference last week, and in the exhibit hall, there was a whole section on the west side populated with exhibitors of Woo. Aisles of woo schools, acupuncture this, homeopathic that, complementary fahrvergnügen.

    There were presentation panels devoted to the use of complementary medicine in public health practice (usually as an adjunct to giving care to immigrants and minorities). Woo galore!

    Of course, this is the same conference that also features a Socialist Caucus.

    I had fun, though. I will probably put more stuff in for next year since the theme is water, and I work on a lot of marine-related illnesses.

    And FWIW, I’ve tried yoga, and hated it.

  11. #11 usagi
    October 31, 2008

    I didn’t need pills to solve emotional “issues,” but rather discipline, breathing and confidence in my body’s ability and connection to spirit.

    How 18th century of you. To think that “discipline” is all that’s required to overcome a chemical imbalance in your brain. And how phenomenally wrong-headed and downright stupid.

    Orac, a few years back, I was a “what’s the harm” skeptic, but with every post like this, you draw out exactly what the harm is. Thank you for fighting the good fight.

    PS Sarah, that “connection to spirit” you’re experiencing, sorry to disappoint you, but it’s your brain chemistry as well.

  12. #12 outre
    November 1, 2008

    spend money on research, or yoga, research… yoga. YOGA!!!

    If I was in research working at Beth Israel, I’d be miffed. OR maybe she can donate that money toward charity care/financial aid for oncology patients. But I guess that doesn’t have enough of that mysterious far East charm…

    Anyone else disturbed by the plan of cork floors? That sounds like something that can get nasty. I’d imagine any flooring material would be sealed but still, cork?

  13. #13 Joseph C.
    November 1, 2008

    Orac, a few years back, I was a “what’s the harm” skeptic, but with every post like this, you draw out exactly what the harm is. Thank you for fighting the good fight.

    I think the harm is that it’s yet another encroachment of religion into the scientific domain. Only it’s not fundamentalist Christians demanding equal time for Creationism in the Biology classroom, but rather it’s New Agers trying to force their spiritual mumbo jumbo into medical practice. Sure Yoga might have mild benefits as light exercise combined with stretching and relaxation techniques. Not a bad idea for anyone really, especially for frail patients who can’t engage in more hard-hitting exercise. But that’s not what they’re selling now is it? Sarah’s post with her references to “the spirit” and her using “materialist” as an aspersion show that she is peddling religion and not a medical treatment modality that can be supported by good science.

    If you want to act as the hospital’s Eastern mystic/yoga guru/death counselor/chaplain to New Age patients who would reject the services of a traditional Christian chaplain, then that’s fine. But don’t call it science.

  14. #14 Lora
    November 1, 2008

    Wow. I wonder if Beth Israel is now farming out more of their serious research? I know the local research affiliates seem to be looking for more collaborations these days, but…wow.

    In some ways, if rich people want to demonstrate their noblesse oblige by building what is essentially a big chapel for ill patients to get some religious counseling, what the hey, it’s their money. I am not against yoga as a form of gentle, non-competitive exercise to build flexibility; rather enjoy it myself as it’s sometimes the only two hours per week that is quiet, relaxed, alone-time. It’s the rich lady’s money, she can do with it what she likes.

    I’m also thinking the homeopathy thing falls under the heading of “giving patients placebos,” especially when it’s parents bitching out the pediatrician for antibiotics to cure Junior’s virally-induced snotty nose, who won’t take no for an answer. Not sure I necessarily have a huge problem with that, other than the necessary disclaimer, “some doctors disagree with this method of medication &c”. I would definitely be interested to see the results of a postmarketing study on Ritalin/Adderall vs. magical homeopathic sugar pills on unruly children though, mostly to see whether appropriate Dx criteria are being used in practice rather than given lip service. I suspect not.

    Oh, and yes, you can seal cork floors and bamboo wallpaper so that it will be scrubbable. Apparently the polyurethane and vinyl coatings don’t interfere with the happy vibes ;-) It makes it less sound-absorbing though. Lots of hospitals are actually looking into this sort of thing, because noise is a real problem–patients find they can’t sleep from the noise of hard-soled shoes, carts, machinery, etc. bouncing off the hard surfaces in most hospitals. Johns Hopkins research on hospital noise

  15. #15 alyric
    November 1, 2008

    “Are you so ignorant to think that extra, tender, loving and holistic care to a patient won’t help them? Are you truly so ignorant to think that the physical body exists without the spirit?”

    Well. yeah they are actually. the young ones at least. There’s this certainty that there;s no such entity as a spirit that may require nurturing, which is a religious belief, but so is the certainty of its non-existence.

    What is bad here is the lack of experimental control. Surely it doesn’t have to be so poor that the results, any results are uninterpretable. Somebody should warn Karan that she’s throwing her money away. She won’t like that.

    Meanwhile, it would be interesting to see if taught meditation makes a difference to say sleep, which is something of a problem with the heavy duty stress associated with cancer and its treatment. Unfortunately because this is so badly done, we’re never likely to find out.

  16. #16 Cath the Canberra Cook
    November 1, 2008

    I love yoga, and it seems like it would be pretty good as a supplement to the proper therapies. Dealing with cancer and chemo must be pretty damn stressful, and a nice relaxing stretch in a room with nice decor, and with a few pleasant scents in the air could well be helpful.

    Note the essential part: it MUST be a supplement, not replacement!!eleventy!11!

    My yoga teacher doesn’t do very much of the woo stuff, except a bit of fluff about chakras and prana – which I choose to interpret as visualisation. I have met some real fruit loops, though, and it worries me what else might get pushed.

  17. #17 The Perky Skeptic
    November 1, 2008

    Joseph C. said:
    “I think the harm is that it’s yet another encroachment of religion into the scientific domain. Only it’s not fundamentalist Christians demanding equal time for Creationism in the Biology classroom, but rather it’s New Agers trying to force their spiritual mumbo jumbo into medical practice.”

    Well-said! You have encapsulated my strongest personal objection to this. Being a refugee from NewAge religion myself, I find it viscerally alarming.

  18. #18 jim
    November 2, 2008

    Take a selection of normal people who are already scared and worried, some in pain.

    Lock them up in a strange place. Isolate them from their own routines, habits and interactions.

    Make the strange place run by untrusted and often deliberately unlikeable strangers with their own priorities and unpredictable methods. Force the people to be subject to their regime.

    Our people aren’t gonna feel great, are they?

    Now provide for them a set of short-term goals, a supportive social environment in which they can find nice people, new friends, some light exercise, learning new skills, stretching themselves to achieve new targets.

    May not make up for the whole experience, but our people are going to feel a bit better.

    If only hospitals did this as standard, here would be no fault line for the woo to seep in through.

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