Respectful Insolence

When PARADE goes woo

Having been sucked into the blogosphere for over four years now and having gotten the majority of my news online or from newsmagazines or the New York Times, I frequently forget that I’m not like the vast majority of people. Neither, I daresay, are my fellow ScienceBloggers or my readers. We don’t get our information from the same sources, and we tend towards a lot more scientific sophistication than the average American. This is not to brag or to claim superiority; it is simply an observation that may help explain to some extent why those of us in the science blogosphere have a hard time understanding the great “unwashed masses” in “flyover country.” We also tend to forget that, as seemingly important to us that many of the issues we discuss here are, the vast majority of people not only don’t read science blogs but are only marginally aware, if at all, of these issues.

Take, for example, PARADE Magazine.

I don’t normally read PARADE. It’s a throwaway magazine that’s included in a large number of newspapers every Sunday. Indeed, it’s circulated in over 400 papers and has a circulation of over 32 million, with a readership in excess of 70 million. Whenever I want an ego check, I consider such numbers and compare them to mine. Even though it continues to amaze me that between 3,000 and 4,000 unique visitors drop in here every weekday, when I see numbers like those of PARADE, I realize my true significance–pretty freakin’ minimal. I also realize these days that PARADE appears to be a major promoter of “alternative” medicine. Witness last Sunday’s issue, which featured an article entitled Alternative Therapies That Work by Dr. Mark Liponis. It identifies “three commonly used mind-body therapies that have scientific backing and have passed the litmus test of rigorous medical inquiry.”

Actually, it doesn’t. Two out of the three modalities identified, for example, are not really “alternative,” but rather another example of the “complementary and alternative medicine” (CAM) movement appropriating relaxation and biofeedback as being “alternative.” The first one, however, is truly “alternative,” namely acupuncture:

ACUPUNCTURE
What it is: Acupuncture is a traditional Chinese practice involving the placement of very skinny, sterile needles into the skin at specific points located along “energy meridians.”

How it works: Eastern philosophy says that acupuncture affects the flow of qi (pronounced “chee”), or energy, through the energy meridians. Western science reasons that the needles interact with our nervous system, triggering the release of hormonelike chemicals that affect our mood, perception of pain, and immune response.

What it’s good for: In a 2004 study, acupuncture was shown to be helpful in reducing pain due to knee arthritis. It also could be beneficial for sufferers of post-traumatic stress disorder. And when used along with in vitro fertilization, it may be effective in increasing the odds of success in female conception. Stimulating an acupuncture point in the toe even may help correct the breech position of babies in the last trimester and allow more women to avoid C-sections, according to a study in the Journal of the American Medical Association.

I really, really hate it whenever an apologist for woo refers to “Eastern” versus “Western” medicine. There’s no such thing. There is only medicine. Moreover, “alternative medicine” is a false label and sets up a false dichotomy. In reality, all “alternative” medicine is is medicine that is either ineffective, unproven, or dubious. It’s possible that some of its modalities may someday be shown scientifically to have some efficacy, but when that happens those modalities will cease to be “alternative” and become just medicine. Whenever you hear someone use the term “Western science” and compare it with “Eastern medicine,” you can be virtually assured that a defense of a dubious or unproven treatment will follow shortly thereafter, usually based on pseudoscience, logical fallacies, or both. Moreover, the in vitro fertilization “study” being referenced is a load of crap, a dubious meta-analysis that shows the principle of “garbage in, garbage out,” as I described in detail earlier this year. Suffice it to say that the article on using acupuncture to correct breech delivery is another poorly conceived meta-analysis that mixed randomized clinical trials with unrandomized retrospective cohort studies.

Unfortunately, this isn’t the only time PARADE has gone woo. Mark Crislip documented another time when PARADE made dubious medical claims, and two years ago, it published a truly execrable article on acupuncture, in which Dr. Isadore Rosenfeld repeated this canard:

My personal experience with acupuncture helps me keep an open mind. In 1978, I was invited to China to witness an open-heart procedure on a young woman. She remained wide awake and smiling throughout the operation even though the only anesthesia administered was an acupuncture needle placed in her ear.

This was thoroughly debunked by Drs. Wally Sampson and Gary Posner.

Even worse, Dr. Liponis has been known to show up on blogs and say some really credulous, woo-friendly things, as he did here, cherry picking studies and saying things like:

I have no idea how it really works, it just seems to work, somehow. Also, as a physician (MD) who sees patients and works with acupuncturists I have also seen many patients helped by acupuncture. I don’t presume to understand how it works.

Ugh. Yet another physician like our “old friend” Dr. Jay Gordon who doesn’t understand that personal clinical experience does not trump science or clinical trials and doesn’t realize just how easy it is for a physician looking at just his experience to confuse correlation with causation or to misinterpret the placebo effect and regression to the mean as an actual treatment effect. Moreover, contrary to the caricature that woo-friendly physicians like Dr. Liponis like to paint, science-based physicians do not dismiss out of hand a treatment effect simply because no plausible mechanism. However, the treatment effect has to be a clear and large effect easily distinguishable from a placebo before we will look at it and decide that maybe something is going on that we do not yet understand. Acupuncture does not qualify, as not only does it not surpass the level of a placebo in its effects, but sham acupuncture is the equivalent of “real” acupuncture–sometimes even better! Meanwhile, Dr. Liponis appears to be showing up on other blogs to say things like this:

I would also say that if you only allow your family to avail themselves of medical treatment that has “demonstrable benefit” and require a standard above those that you label as “poorly done”, then your family would have very little medical care at all, because MOST of the care provided by doctors has not been studied at all, especially so in women and children, and very little to the degree you seem to consider necessary. Most prospective, RCTs are still centered on the effects of drugs and have been funded by the pharmaceutical industry.

Many simple things that we take for granted (vaccines, antibiotic use, primary prevention, CPR, cardioversion, surgical procedures, treatment of back pain, cancer treatment and so many other accepted therapies) have just not been studied by good prospective RCTs. Even if you ask yourself a simple question, like “what if my wife was diagnosed with breast cancer?” you will be hard pressed to find studies that give you clear answers about the right treatment. Even the use of mammography… at what age should you screen? Colonoscopy… the list is very long. And most preventive and screening tests analyses are limited to cost-benefit analysis. Is that what you’d want for your family, also, or would you be willing to pay more to insure better health and safety for your loved ones?

Dr. Liponis is parroting the old “most ‘conventional’ treatments don’t have good RCT evidence” canard so beloved of defenders of quackery! It’s the zombie that won’t die, a vampire that needs a stake in the heart. It never goes away no matter how many times it’s explained that it’s a load of BS. Steve Novella pretty roundly debunked that one about a year ago! Moreover, this particular red herring beloved of apologists for unscientific medicine is also based on a false premise, namely that boosters of science- and evidence-based medicine consider RCTs are the only form of acceptable evidence and that anything else is, as Mike Myers likes to say with a Scottish accent, crap. Not true. The prospective, double-blind RCT may be the gold standard, but there are lots of questions that can’t be studied ethically or practically by this sort of RCT. So often we rely on the preponderance of evidence from studies as well-designed and controlled as possible. Sometimes it’s non-blinded RCTs. Sometimes it’s retrospective data. Sometimes it’s epidemiology. It’s lesser quality evidence but much better than anecdotes. (I do note that in some cases, such as for the question of whether vaccines cause autism, good epidemiology can be nearly as powerful as a double-blind RCT.)

Worse, it’s a load of fetid dingo’s kidneys to claim that antibiotic use, vaccines, primary prevention, and other therapies haven’t been studied by good RCTs. Give me a break! CPR and surgical procedures, maybe, mainly because of the practical and ethical difficulties involved (you can’t ethically withhold CPR from a patient in cardiac arrest and you can’t easily–or sometimes ethically–blind patients or surgeons to surgical procedures). Dr. Liponis also doesn’t know what he’s talking about when it comes to breast cancer. Most cases of breast cancer have a fairly limited set of treatment options recommended on the basis of high quality evidence from large cooperative group trials. Geez, just search PubMed or look at the NSABP website to get a start. True, a minority of patients will fall into the cracks between existing clinical trials, and those are the ones that often get referred to cancer centers like the one that I work at, but to use breast cancer as an example of a cancer for which there are “no clear answers” about the right treatment is simply not true in most cases. And it’s not true exactly because large numbers of high quality randomized prospective studies have been carried out, many be large multiinstitutional cooperative groups enrolling thousands of patients. If his goal is to claim that most “conventional” medicine isn’t backed by a lot of prospective RCTs, Dr. Liponis couldn’t have chosen a worse example if he had tried! Breast cancer is among the best-studied diseases with the most RCT data to support recommended treatments.

No wonder he writes for PARADE and says things like “acupuncture has passed the litmus test of rigorous medical inquiry.” Maybe that’s the best place for him–or not. I don’t like thinking that someone like him has an audience of 70 million. There’s enough misinformation about “alternative” medicine out there.

Comments

  1. #1 SC
    December 17, 2008

    PARADE is garbage in so many, many ways – thanks for pointing to one of the more serious.

    Even though it continues to amaze me that between 3,000 and 4,000 unique readers drop in here every day, when I see numbers like those of PARADE, I realize my true significance.

    What – no comparison with PZ Myers’ numbers, stating in continuation that even his readership is dwarfed by PARADE’s? That’s so unlike you. ;)

  2. #2 BB
    December 17, 2008

    Accupuncture can correct a breech presentation? Seriously? You mean I had a C-section for nothing????????

    Dang.

  3. #3 Interrobang
    December 17, 2008

    The more I read about people like Liponis and Gordon, the more I love my (citation-providing, “you should look up this article on PubMed”) doctor, who is truly a Big Medical Nerd.

    One of the reasons I keep coming back to this blog is that you and people like you help people like me (non-science Master’s degree and the usual courses in research methodology) judge the quality of sources outside our fields. Outside of the very most top-ranked journals that are household names (if your household is as nerdy as mine), it’s often hard to judge impact factor in a field with which you’re not tremendously familiar. I’m not in the academy anymore, but that doesn’t mean I don’t want to have good citations!

  4. #4 Denice Walter
    December 17, 2008

    Mark Liponis!Right!My SO likes to buy used books for 25 cents each at a nearby glitzy library; among the usual travel books was ,”Ultra Prevention:The 6-Week Plan That Will Make You Healthy for Life” by Liponis and Mark Hyman(2003).He asks whether it is woo or not, as to him,”It sounds like woo, but the authors are both MD’s”.I look at the Contents page and find: “Controlling the Five Forces of Illness”(i.e.,sludge, burnout,heat,waste, and rust.)Enough said.Be that as it may, the book was highly entertaining,although it did not provide as much “Bang for the (quarter) Buck” as did “Coastal California”.

  5. #5 skepticpedi
    December 17, 2008

    Thanks for covering this Orac, and I appreciate the link to my post. Now I’ve got my local news touting the benefits of ear candling. Why don’t these things die? I know the answers of course but I still have trouble wrapping my brain around the whole thing.

  6. #6 Blake Stacey
    December 17, 2008

    among the usual travel books was ,”Ultra Prevention:The 6-Week Plan That Will Make You Healthy for Life” by Liponis and Mark Hyman(2003)

    That second guy sounds like a real cu—

    [Blake is seized by a giant hook and pulled off the blogostage]

  7. #7 gort
    December 17, 2008

    A local hospital in Milwaukee is advertising that they use a holistic approach along with traditional medicine. The specific example they give is teaching pregnant women self-hypnosis to reduce stress, and thus pain, during delivery. Is this woo or an effective alternative medicine procedure?

  8. #8 D. C. Sessions
    December 17, 2008

    CPR may not be double-blinded, but there are a lot of population-based comparison studies. The new “hands only” resuscitation protocol was run in my area, with comparisons between matched populations and team protocols.

    When you get a 3:1 improvement in patient survival, it’s time to close the trial.

    As for CPR vs. no CPR, it’s another great example. When you’re dealing with a corpse (no pulse, no respiration) we have lots of case-control comparisons available. C*R may not save them all (and I’ve lost a couple) but I don’t know very many people with DNR tattooed on their chests.

  9. #9 D. C. Sessions
    December 17, 2008

    The specific example they give is teaching pregnant women self-hypnosis to reduce stress, and thus pain, during delivery.

    Sounds like bog-standard Lamaze to me.

    Getting people to think about something other than pain, thus relax, thus reduce muscle tension (which often contributes to pain) etc. is pretty routine. I’ll let someone who does more than field first aid comment beyond that point, but call it what you will it’s sure part of my tool set.

  10. #10 The Perky Skeptic
    December 17, 2008

    Was about to post an “Oh, hooray, glad you linked to this” but then Blake Stacey’s comment made me die laughing.

  11. #11 I am so wise
    December 17, 2008

    BB,

    Na, you just received the effective form of Eastern Medicine to correct a breech birth. After all, C-sections are ancient Eastern Medicine like accupuncture and TCM.

  12. #12 BB
    December 17, 2008

    @Gort, Lamaze is sort of self-hypnosis. And although woo-like, it does work in that women who use Lamaze require less pain relief than women who don’t.

  13. #13 Trin Tragula
    December 17, 2008

    mind-body therapies

    I didn’t even have to get to the “litmus test” part to know that this was going to stink.

  14. #14 Joe
    December 17, 2008

    I am surprised Liponis was not plugging his new book on how to live 150 years. I’ll let you in on the secret- it’s all about the food you eat and how that affects your immune system.

    Liponis is the medical director at Canyon Ranch, a fat farm offering many types of quackery in western Massachusetts (it is part of a national franchise). Their motto seems to be “If the woo fits bear it.”

  15. #15 Patrick
    December 17, 2008

    There is no way to fail a litmus test, Dr Lipo, from the fat farm no less! Please have someone that knows what in the heck they are doing try a more appropriate test for the condition of meeting rigorous medical inquiry.

  16. #16 Karl Withakay
    December 17, 2008

    The internet version of Parade? The Yahoo home page which frequently links to wooish and semi-wooish articles about health and fitness.

  17. #17 cm
    December 17, 2008

    re: PARADE, my first adult-like decision in life, made when I was about 12, was to ban myself from ever again reading the Howard Huge cartoon in PARADE. Even then it struck me as a funny-destroying black hole.

  18. #18 Melissa (oddharmonic)
    December 17, 2008

    I played Peter, Paul and Mary over headphones to my lower abdomen to get my 36 weeks’ gestate to get her head down. Therefore, playing Peter, Paul and Mary is as effective as acupuncture! </snerk>

    (I had scheduled a version at 38 weeks in a hospital in case she was still in breech position at that point. She turned on her own sometime in the few days prior to it.)

  19. #19 TherExtras
    December 17, 2008

    Review ‘exercise’ as treatment, please.

    I expect you will need to distinguish ‘exercise’ from ‘prescribed exercise’.

    Operational definitions are very important. A concept seemingly unknown to Dr. Liponis.

    The problem that some 50+million Americans get their medical information from Parade Magazine is another issue to work-on, please.

  20. #20 Supreme Turkey Overlord
    December 17, 2008

    Karl,

    The internet version of Parade Magazine is http://www.parade.com.

  21. #21 cm
    December 17, 2008

    TherExtras, could you submit your comment a few more times?

  22. #22 Cath the Canberra Cook
    December 17, 2008

    I risked my braincells and sneaked a peek. Just for a brief moment, I was thinking that they got at least one right – meditation.

    But no!!! They have to go for the loony version: TM. TM is a cult started up in the 60s by some self-styled guru. It’s purported to make you fly and bring about world peace and other bullshit claims. Even the term “Transcendental Meditation” is trademarked. Argh!

    Well, that’s my soapbox. Des anyone know anything about the third item, biofeedback?

  23. #23 mandydax
    December 17, 2008

    I wonder what Marilyn Vos Savant thinks of the woo in Parade. She’s married to Dr. Jarvik (the artificial heart guy) and incredibly intelligent herself. She probably can’t dis it by contract or some-such. :(

  24. #24 Joshua Zelinsky
    December 17, 2008

    PARADE is one of the biggest wastes of paper in existence. I generally only read it to know what misinformation or trivial celebrity nonsense that are being fed to the masses. I’d love to find a way to rewrite that sentence so it wasn’t so snobby and elitist and only mildly elitist but I really don’t know how. Parade is junk. There’s just no other description. I’ve met only one person in my entire life who had a high opinion of it and she was a bloody idiot.

  25. #25 D Johnston
    December 18, 2008

    Great work as always, Orac. I would like to throw in one little detail. From the PARADE article:

    Acupuncture is a traditional Chinese practice involving the placement of very skinny, sterile needles into the skin at specific points located along “energy meridians.”

    Um, no. I’ve studied enough Sinology to know about “traditional Chinese medicine” and I can tell you that whatever gets labeled acupuncture these days has very little to do with what the Daoists were doing thousands of years ago. Acupuncture ties into the Five Phases theory, and as such the original practice involved the use of five different needles, each one a different shape and made from a different material. I’ve seen these things – the smallest was about the size and sharpness of a ten penny nail, and some of the bigger ones were thicker than your pinky finger. A small point, maybe, but you’d think that these people obsessing over TCM would want to practice the actual traditional methods. There’s nothing “traditional” about sterilized, mass-produced, surgical steel needles.

  26. #26 mark
    December 20, 2008

    the litmus test of rigorous medical inquiry

    …Endorsement by a celebrity.

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