Respectful Insolence

Yesterday, I wrote about Senator Tom Harkin’s (D-IA) little woo-fest in the Senate’s Committee on Health, Education, Labor, and Pensions, which he called Integrative Care: A Pathway to a Healthier Nation. I and a lot of the rest of the medical blogosphere (such as PalMD, Val Jones, and Tufted Titmouse) shook our heads in disbelief and disgust at Harkin’s statement (video here) about 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.

Although I was actually somewhat happy that he did it for all to see, I couldn’t believe that Harkin actually laid it on the line so bluntly about what the true purpose of NCCAM was from its very founding. Harkin’s admission showed that, for all its promotion of pseudoscience, CAM “fellowships,” and bad science, even that is not enough for promoters of woo like Senator Harkin. Even though NCCAM is incredibly friendly to pseudoscience, it has still failed to “validate” a single alternative medicine. The closest it’s come is for various natural products, but testing plants and herbs for medicinal compounds is nothing that can’t be done in all the other Institutes and Centers that make up the NIH. It does not need a special center. In any case, Harkin’s admission also made clear that NCCAM, even in its current form, is still too “science-y” for woo-philes, who have wanted it from the very beginning to give unscientific quackery a patina of scientific respectability and to “prove” that woo works. When, even under the easiest testing, reality does not conform to their preexisting beliefs, they lash out and try to pressure NCCAM to “validate” more woo.

Senator Harkin, as you may recall, is the legislator who, above all others, is responsible for the creation of the pseudoscientific monstrosity that is NCCAM. He based his championing of “alternative medicine” on an anecdote about a friend of his from the House of Representatives who became ill, tried alternative medicine, and supposedly got better, combined with his own belief that bee pollen cured his allergies. But even a Senator as senior and powerful as Tom Harkin can’t do it alone. Even he needs help. And, to help him, he brought in the Four Horsemen of the Woo-pocalypse into the very chambers of the Senate, as a two-fer from their concurrent engagement at the Institute of Medicine and Bravewell Collaborative woo-fest being held on the same days: Dr. Andy Weil, Director, Arizona Center for Integrative Medicine, University of Arizona, Vail, AZ; Dr. Dean Ornish, Founder and President, Preventive Medicine Research Institute, Sausalito, CA; Dr. Mark Hyman, Founder and Medical Director, The UltraWellness Center, Lenox, MA; Dr. Mehmet C. Oz, Director, Cardiovascular Institute and Complementary Medicine Program, New York-Presbyterian Hospital, New York, NY.

It was the opening shot in the war against science-based medicine, using President Obama’s desire and plan to reform the health care system as the vehicle upon which to piggyback quackery.

First off, the way that Senator Harkins fawns over these luminaries of of faith-based medicine is truly disgusting to behold. At one point, he even says:

I don’t mean to be pandering but you’re all my heroes and we need you involved in our healthcare reform platform.

Gag me with a spoon. (I know, that’s really ancient history.) However, there was enough of that that I really couldn’t stomach listening to the full hour and a half. Instead I surfed and sampled.

Let’s look at the opening statements of these four leaders of the CAM movement. At the risk of echoing too closely my blog bud PalMD, I found Mehmet Oz’s initial statement to be particularly full of weasel words of woo:

We spend roughly twice as much per capita on healthcare than our counterparts in Europe, but do not appear to derive value for this investment. Part of the reason is that Americans are twice as sick as Europeans as a people because of our chronic disease burden.1 Since lifestyle choices drive 70% of the aging process, most experts agree that we should focus on what we put in our mouths (food and addictions), how we tune our engines (exercise and sleep) and how we cope with stress (community and psychological growth). A key solution is support for a Smart Patient movement that integrates complementary and alternative medical (CAM) approaches to conventional medical treatment. We can combine the best of modern American medical practices with alternative approaches to wellness and harvest the natural healing powers of our bodies. CAM is not just about extreme treatments for advanced disease when no other solutions are available. It is about taking a population that has gotten comfortable living with half of the energy and sense of physical well being that they should have at their age and moving them up the spectrum to live at full vitality.

I note that the one reference Oz cites to support this load of CAM-speak is not even from a scientific journal. Rather, it comes from a health policy journal journal. But let’s say for the moment that there are higher rates of chronic diseases in the U.S. and that they are primarily due to poor lifestyle and diet. There is no doubt that obesity rates have increased markedly over the last 25 years. Let’s grant Oz that. Even if everything he says is true (although I have no idea what he means by lifestyle choices driving “70% of the aging process”), that does not mean that the answer to the problem is to embrace pseudoscience. CAM advocates ensconce themselves within the Trojan horses of diet and lifestyle modifications and ride that Trojan horse into the fortresses of medical academia and health policy, where the quackery lying within leaps out to take over. In other words, as I’ve said time and time again, by so closely trying to relabel healthy diet and exercise as being somehow “alternative,” they hope to get their foot in the door to let all the other woo in behind it.

Oz then continues:

As Vice-Chair and Professor of Surgery at Columbia University and Director of the Heart Institute at New York Presbyterian, I’m in the operating room every week and have performed thousands of heart operations utilizing the most state-of-the-art equipment and innovative approaches of science in order to save lives. I spent much of my life past the cutting edge as I operated on the bleeding edge of medicine. My specialty was mechanical heart pumps (See Appendix A – Visual of Mechanical Heart Pump) and transplantation and my patients were barely gripping the ledge of life as they pulled themselves up from the crevice of death. To survive, they needed a pump to replace their failing organ, but this was not enough. They also wanted to return to a fulfilling life, so they introduced me to their “other” healershypnotherapists, massage therapists, spiritual healers, and even energy medicine experts like Reiki masters. Clearly these patients had not read the same books that I got in medical school.

So we began offering massage and meditation, and even audiotapes in the operating room with some internal resistance, but general support from a medical community that recognized that conventional medicine alone could not offer the robust, holistic approach that our patients deserved. We started a center where we paid salaries of complementary and alternative medical (CAM) practitioners to offer free services to all of our heart surgery patients. We had two goals. First introduce patients to new powerful lifestyle approaches that they could do on their own after discharge. Second, evaluate rather than just advocate these unconventional approaches to see what works and spread the word by publishing in mainstream journals. We researched if we could reduce pain medications with hypnosis, if we could improve survival after heart procedures with prayer, and if we could alter memory with what patients hear during their operations. As we merged high tech to low tech approaches, folks around the hospital started to notice, and so did the media as evidenced by this early piece in the New York Times Magazine.

Notice that Oz’s statement is almost completely science-free. “To see if we could improve survival after heart procedures with prayer?” That’s been tested, and intercessory prayer has failed miserably. I also find it funny that, for all Dr. Oz’s grandiose braggadocio about how he’ll study this woo and publish on it, I find his publication record, although impressive in standard cardiovascular surgery, mighty short on scientific publications testing or studying alternative medicine. (Of course, I can’t help but reiterate my belief that, with rare exceptions, “scientific alternative medicine” is an oxymoron.) Later, he tries to sell alternative medicine as the “globalization” of medicine and states baldly, “The globalization of medicine mandates that we incorporate foreign approaches like traditional Chinese and Ayurvedic healing practices into Western medicine.” In other words, we poor advocates of scientific medicine are hopelessly “provincial,” as he puts it, for not being sufficiently open-minded that our brains fall out. Personally, I would argue that it is alternative medicine that is provincial. After all, it’s often based on culture-specific religious beliefs, especially so-called “traditional Chinese medicine” (TCM) I would counter that it is science- and evidence-based medicine that is truly the globalization of medicine. Science knows no cultural boundaries, and even the younger generation of Chinese are rejecting TCM in droves.

Next up is Mark Hyman, who tells us that so-called “functional” medicine is the way:

  • This new paradigm is personalized, preventive, participatory, predictive, and patient centered. It is proactive rather than reactive. It is based on addressing the causes of disease and optimizing biologic function in the body’s core physiologic systems, not only treating the symptoms.
  • It based on systems biology or medicine. That model exists today, and is called Functional Medicine.
  • Functional medicine is a system of personalized care, a new “operating system” that directly addresses how environment and lifestyle influence our genes to create imbalances in our core biologic systems that, over time, manifest as disease. It is this kind of medicine that is needed to create real successes in 21st century medicine.

Functional medicine is highly dubious, based not on science, but seemingly on a grab bag of popular CAM myths and misconceptions. Whenever you hear the term “personalized medicine” used in this manner, as Wally Sampson correctly points out, what is really being said is a codeword for total freedom to deviate from the standard of care based on no science. As for the whole “operating system” analogy, that’s just a glib but meaningless catchphrase. Functional medicine is in fact a woo-filled pseudoscientific version of systems biology applied to health care–without the science and gene profiling. Systems biology may be at the cutting edge of science, but it may end up going nowhere as well. “Functional” medicine is no more than hijacking the term. Indeed, look at how Hyman refers to “core imbalances” that result in disease. Sound familiar? It should. It’s no different than “imbalances of the four humors” (or “imbalances” between yin and yang or a person’s qi) or a more high tech-sounding version of the German New Medicine, which postulates that disease is a manifestation of imbalances caused by emotional trauma. In other words, it’s very old, vinegary wine in a new cask, supported by nothing but anecdotes.

Next up we have Dean Ornish. I’ve written about Dean Ornish before. My overall impression is that he wants to be scientific (or at least to appear scientific) but just doesn’t know how to do it right, which leads him to do studies of his rather radical diet using cDNA microarray technology and then exaggerating the results, which he does again here:

We used high-tech, state-of-the-art measures to prove the power of simple, low-tech, and low-cost interventions. We showed that integrative medicine approaches may stop or even reverse the progression of coronary heart disease, diabetes, hypertension, obesity, hypercholesterolemia, and other chronic conditions. We also published the first randomized controlled trial showing that these lifestyle changes may slow, stop, or even reverse the progression of prostate cancer, which may affect breast cancer as well.

No, that’s not what he did, as I explained in my usual nauseating detail last summer. At best, what he did is to show that a very severe dietary and exercise regimen may favorably change gene expressoin profiles in a small, very highly select, group of men with early stage, well-differentiated prostate cancer. He then spews this bit of nonsense:

Our research, and the work of others, have shown that our bodies have a remarkable capacity to begin healing, and much more quickly than we had once realized, if we address the lifestyle factors that often cause these chronic diseases. Medicine today focuses primarily on drugs and surgery, genes and germs, microbes and molecules, but we are so much more than that.

Damn those scientific doctors for concentrating on the actual causes of disease! Also note the assumption that we are “more than that.” It almost sounds as though he’s arguing that we humans are more than our biology, which is, after all, what science- and evidence-based medicine uses as the basis for its treatments.

Finally, we have the macher of the CAM movement, the Big Kahuna himself, Andrew Weil. His testimony shows why he’s the big dog, the top gun, the number one woo-meister in the entire U.S. Weil doesn’t disappoint, either, laying it on thick. First, we have the biggest lie about alternative medicine that there is, but, alas, it’s the most effective because it contains at its heart a small grain of truth.

For practitioners of IM, preventing disease is not an afterthought, it is the cornerstone of our practice – the physician and patient form an ongoing partnership to maintain health, rather than fight illness, and IM practitioners are trained to be agents of lifestyle change. We treat illness promptly and aggressively when appropriate, but always seek to maximize the body’s innate capacity to stay healthy and resist disease and injury.

The lie is that preventing disease is an afterthought to science-based practitioners. It’s not, despite all the attempts of CAM advocates like Andrew Weil to coopt prevention for their own sectarian ends. The grain of truth is that, given the constraints of modern medical practices, physicians practicing science- and evidence-based medicine fail more often than they should in emphasizing prevention to patients. It’s difficult; it takes time; and there aren’t enough hours in the day, given the current reimbursement system. Moreover, patients resist it; they like their crappy lifestyle changes. Changing behavior is very, very difficult. Of course, that scientific medicine arguably too often doesn’t do enough to emphasize prevention of does not mean that the solution to this shortcoming is to embrace woo. (I know, I’m repeating that a lot, but these CAM aficionados are so repetitive in their mischaracterization of both scientific medicine and their abilities.) He’s also suffering delusions of grandeur if he thinks that CAM practioners do anything to maximize the body’s innate anything.

And, of course, Weil can’t resist argumentum ad populum:

Consider: Integrative medicine is quickly gaining momentum. I founded the first integrative medicine training program at the University of Arizona in 1992,. Today, 42 academic health centers, including those at Harvard, Duke, Johns Hopkins, and the University of California as well as the Mayo Clinic, have IM initiatives. [source: http://www.imconsortium.org/about/home.html] At the University of Arizona alone, we have trained over 400 physicians, nurse practitioners, and medical residents, many of whom are now leading their own programs at other institutions in this country and around the world. We are expanding our trainings as quickly as we can, because demand for them is increasing rapidly, and are working to make a comprehensive curriculum in IM a required, accredited part of all residency training in all medical specialties. I can assure you, that more and more doctors and allied health professionals want to practice this kind of medicine, because they see it as the medicine of the future: cost-effective medicine that can revitalize American health care and make it truly the best in the world.

Consumers have already embraced integrative medicine, but skeptics still question whether it really works. We need good outcomes studies to convince them, but we already have data showing that patients do indeed achieve better outcomes and are more satisfied with their care when treated by integrative physicians. For example, a 2008 study of patient experiences at the University of Michigan’s Integrative Medicine Clinic showed that over 62 percent of responding patients called the clinic’s care either “excellent” or “best care ever.” An amazing 81.2 percent of respondents reported partial or full effectiveness of their patient plan in achieving their primary objective. [source: http://www.liebertonline.com/doi/pdf/10.1089/acm.2008.0154] That is a success rate most conventional clinics could not match.

Note how he confuses–intentionally, I would argue–popularity with scientific validity. Let’s put it this way. Lots of people (over 50% of people in the U.S., by some surveys) do not believe in evolution. Lots of people believe in ghosts. Heck, lots of people believe that aliens are visiting earth and abducting people to do experiments on them. That does not make any of these things science. Moreover, lots of people who see, for example, psychics believe that they got the best service of their lives. Pay some personal attention to people in a pleasant environment, listen to them, and they will be satisfied. “Conventional” medicine has a hard time matching that. Also note what Weil seems to contradict himself. He says that he has data showing that patients achieve better outcomes with “integrative” medicine, but does he discuss that data? No! Rather, he discusses, in essence, consumer satisfaction surveys that find that people like the woo CAM practitioners are dishing out. Get a load of the abstract’s conclusion:

Using three tools to evaluate patient outcomes and satisfaction, statistically significant outcomes were noted. The SF-12 showed positive change in the physical component score, the Holistic Health Questionnaire showed improvements in all of the subscales of body, mind, and spirit, and a unique Integrative Medicine Patient Satisfaction Tool suggested high satisfaction with an integrative approach to care.

Twisting the knife in my heart, this paper was published by my alma mater, the University of Michigan. Oh, woo is me!

The bottom line is that the strategy of CAM advocates that I warned about early this year is now being implemented. CAM-friendly legislators like Tom Harkin are being used to give CAM supporters a forum in the halls of power to push their agenda. There, they do their best to falsely conflate disease “prevention” with alternative medicine by emphasizing diet and exercise while hiding the bizarre methodologies in CAM, such as reiki, homeopathy, and the like, knowing that if they are successful, after they become the accepted “experts” in diet, exercise, and nutrition that they can bring the woo in later in increasing doses.

Be very, very afraid. The age of scientific endarkenment could well be on its way in medicine, unless the President Obama truly meant what he said in his inaugural address when he stated that he would “restore science to its rightful place.” To do so, he’s going to have to fight a lot of powerful interests who very much don’t want that to happen. Not all of these powerful interests reside in the Republican Party.

Comments

  1. #1 PalMD
    March 3, 2009

    I love it when Orac uses Yiddish.

    I’ll add a few yiddishisms for ya:

    narishkeit, dreck, drei kop

  2. #2 Dr Benway
    March 3, 2009

    “…they introduced me to their “other” healers: hypnotherapists, massage therapists, spiritual healers, and even energy medicine experts like Reiki masters.”

    Sorry woo-boys, you can’t steal “healing” or “healer” for your side of the table. Anyone caught saying things like: “traditional medicine seeks to cure diseases; alternative practitioners seek to heal the sense of suffering or illness,” shall be liable to a swift kick in the shins.

    You can’t steal “prevention” either. Particularly you antivaxers.

    Nor “nutrition.” Anyone caught saying, “doctors don’t learn much about nutrition in med school,” shall be made to piss off.

  3. #3 Dr Benway
    March 3, 2009

    Y’know, we could get strippers to visit patients in the hospital. That might raise a few spirits in the recovery room.

  4. #4 sam
    March 3, 2009

    @ Dr Benway, but what about the ensuing heart attacks if we have strippers? (nicest form of euthanasia yet!)

    Its quite depressing how seemingly easy it is for non-science to get a platform the world over, people who argue that ‘there are two sides to every argument’ need to be kicked and reminded that one of those sides is often ‘tea-pots made me do it’

    good post orac!

  5. #5 Mike
    March 3, 2009

    There is a model for how this unscientific quackery gets put into policy. The model to study is the organic foods movement. That policy was implemented without any scientific evidence that it was worthwhile. A similar approach is being taken by the CAM supporters in order to have the federal government give CAM a stamp of approval.

  6. #6 MitoScientist
    March 3, 2009

    We need to get Orac and all the writers at Science-based Medicine in front of Congress, and let the defenders of reason be heard!

  7. #7 Calli Arcale
    March 3, 2009

    “Y’know, we could get strippers to visit patients in the hospital. That might raise a few spirits in the recovery room.”

    Among other things. ;-)

  8. #8 Jonathan Dresner
    March 3, 2009

    I just dropped a note in Sen. Harkin’s inbox:

    I lived in Iowa a while back, and I was quite proud to be represented in the US Senate by Mr. Harkin, a strong liberal voice with solid roots. It disturbs me, then, to discover that Mr. Harkin is promoting mysticism and handwaving as an “alternative” to reality-based medicine. I’m quite supportive of the scientific mission of NCCAM — within the limits of our resources, all ideas should be tested and, if effective, shared and used. But it is folly to complain about scientific rigor when that is precisely what is needed to avoid wasted money and time on “traditional” methods which do not work. It would be nice, to be sure, if we could find cheap, natural methods for healing: we often have, in the form of good, balanced diet and complex foods like garlic. But we take them seriously because they have proven effective in real testing and with solid epidemiological analysis.

    Wishful thinking is not medicine. It may be therapy, but it’s not going to be a cure for anything. I would like to see Senator Harkin return to the roots of liberalism — clear thinking, evidence, the search for answers instead of faith — and give up this silly grandstanding in the service of dead-end pseudoscience.

    I’m not an Iowan anymore, I’m afraid, but I am a politically active Democrat, a donor to campaigns and someone who takes a keen interest in the process by which money and science interact. I could not possibly support Senator Harkin’s future campaigns under these circumstances.

  9. #9 Mojo
    March 3, 2009

    A key solution is support for a Smart Patient movement that integrates complementary and alternative medical (CAM) approaches to conventional medical treatment.

    This must be some usage of the word “smart” of which I was previously unaware, possibly meaning “gullible”.

  10. #10 DLC
    March 3, 2009

    Dr Benway has an idea.
    The strippers would at least get some heart and respiration rates increased. outside the cardiac care unit it might actually be beneficial — more so than can be said of Reiki handwavers or spoon-benders or whatever it is.
    Perhaps the Right Honourable Mr Harkin will volunteer to be treated by a “Reiki Master” when he has a heart attack ?
    Sure. don’t take that nitroglycerin for angina, just get some guy to wave his hands. don’t do surgery to correct a blockage in a coronary artery, just down some homeopathic sugar pills!
    I’ll even get you some homeopathic water to wash it down with!

  11. #11 Sid Schwab
    March 3, 2009

    Include me among those who’ve commented on the idiocy. As a liberal, it’s embarrassing.

  12. #12 D. C. Sessions
    March 3, 2009

    This must be some usage of the word “smart” of which I was previously unaware

    I’m sure you have:

    smart (adj): sharply severe, as a blow, stroke, etc.

  13. #13 Jon H
    March 3, 2009

    Isn’t Iowa a hotbed of Transcendental Meditation woo?

    Ah, yes, Maharishi Vedic City, Iowa.

    http://www.maharishivediccity-iowa.gov/

    Yes, that’s a .GOV.

  14. #14 Dean Ornish, M.D.
    March 3, 2009

    For someone who prides himself on attention to detail, it’s surprising that you haven’t done your homework. My testimony that comprehensive lifestyle changes may affect the progression of early-stage prostate cancer was not based solely on the paper that my colleagues and I published in the Proceedings of the National Academy of Sciences last year (Proc Nat Acad Sci USA 2008; 105: 8369-8374. Ornish D, Magbanua MJM, Weidner G, et al. Changes in prostate gene expression in men undergoing an intensive nutrition and lifestyle intervention. Proc Nat Acad Sci USA 2008; 105: 8369-8374).

    It was based on a randomized controlled trial that I directed in collaboration with Peter Carroll, M.D. (Professor & Chair of Urology, School of Medicine, University of California, San Francisco) and the late William Fair, M.D. (Chief, Urologic Surgery and Chair, Urologic Oncology, Memorial Sloan-Kettering Cancer Center) which was published in one of the leading peer-reviewed urology journals (Ornish DM, Weidner G, Fair WR, et al. Intensive lifestyle changes may affect the progression of prostate cancer. Journal of Urology. 2005;174:1065-1070). Other subsequent studies have shown similar findings.

    In September, we published a pilot study in The Lancet Oncology in collaboration with Dr. Elizabeth Blackburn, who was awarded a Lasker prize for discovering telomerase, showing that these comprehensive lifestyle changes increased telomerase by almost 30%. This is the first study showing that any intervention may increase telomerase.

    Our earlier studies showing that comprehensive lifestyle changes may stop or reverse the progression of coronary heart disease were published in several peer-reviewed journals, including:

    • Ornish D, Scherwitz L, Doody R, et al. Effects of stress management training and dietary changes in treating ischemic heart disease. JAMA. 1983;249:54-59
    • Ornish D, Brown SE, Scherwitz L, et al. Can lifestyle changes reverse coronary atherosclerosis? The Lifestyle Heart Trial. The Lancet. 1990; 336:129-133.
    • Gould KL, Ornish D, Scherwitz L, et al. Changes in myocardial perfusion abnormalities by positron emission tomography after long-term, intense risk factor modification. JAMA. 1995;274:894-901.
    • Ornish D, Scherwitz L, Billings J, et al. Intensive lifestyle changes for reversal of coronary heart disease Five-year follow-up of the Lifestyle Heart Trial. JAMA. 1998;280:2001-2007.

    You can do a medline for more references.

    Although you dismiss this statement as “nonsense,” we are, in fact, more than just genes and germs, microbes and molecules. You might begin by reading some of Leroy Hood’s work (no slouch as a scientist) who described systems biology and the concept of synergy. I cited his work in my keynote talk at the recent Institute of Medicine’s “Summit on Integrative Medicine” at the National Academy of Sciences that will be posted later this week (http://www.iom.edu/integrativemedicinere) in which I describe the studies of those such as Sheldon Cohen in JAMA showing that not everyone who is infected with rhinovirus develops the signs and symptoms of a cold, and found a direct relationship between the degree of social support and immune function.

    The best scientists are open to new ideas, not glibly dismissing them just because they don’t agree with their preconceptions.

    Dean Ornish, M.D.
    Founder and President, Preventive Medicine Research Institute
    Clinical Professor of Medicine, University of California, San Francisco

  15. #15 Interrobang
    March 3, 2009

    Not that I’m a Yiddish-speaker by any means (though I read it reasonably well), but isn’t the correct Yiddish term for people like Andrew Weil “kombinator“?

  16. #16 Ace of Sevens
    March 3, 2009

    I live in Iowa. Fairfield is not representative of the state. However, there are plenty of people buying into “The Secret” and related crap. The real problem is Evangelicals, though.

  17. #17 Jud
    March 3, 2009

    I think the appropriate Yiddish for woo-meisters and supporters is “Tuches affen tisch,” a vernacular translation of which is “Put up or shut up,” and the literal meaning of which is, quite wonderfully, “Ass on the table.”

    Pronunciation is approximately TOO-hess AH-fen tish, though in the first word the “h” sound should be pronounced more like a Germanic “ch” (try saying an English “sh” with the middle of your tongue raised to the roof of your mouth).

  18. #18 Michael D
    March 3, 2009

    I was surprised to see Mark Hyman so flayed in this post. I read his book Ultrametabolism and recall enjoying the book and learning some interesting things about nutrition and metabolism. I have zero patience for homeopathy, naturopathy, or vague references to energy, etc. but don’t recall any warning lights going up.

    After going back to Amazon to read some of the negative reviews, most were based on “nothing new here” or his inflating past research.

    I have to admit I had no idea what his testimony referred to (functional medicine) but it took it to mean improve diet, get more exercise, examine levels of stress and what leads to happiness. If he means people taking more responsibility for basic choices in their lifesyle, bravo. If he means deciding what reality is, boo hiss.

    I did get the sense he assumes more of a benefit to supplementation for people without vitamin or mineral deficiencies than is warranted, but that’s low on my list of annoying CAM beliefs.

    I’ll probably go back and skim the book with a more critical eye. But I find it sad that Dr. Hyman and Dr. Oz have to go beyond a welcome advocacy of basic and useful health information (Dr. Oz does present some helpful information on Oprah, for example) into the realm of woo. That being said, it’s not clear to me that overall either does more harm from good. I think following Dr. Hyman’s diet, if one could tolerate the food and afford the prices, would increase the health of most Americans.

  19. #19 Who Cares
    March 4, 2009

    To hijack this thread a bit.
    They have found a possible link between Autism and GI problems. It is just not what our colonoscopy happy quack thinks it is.
    Just check out the following link (note scienceblog not scienceblogs):
    scienceblog.com/cms/usc-researchers-identify-gene-variant-associated-both-autism-and-gastrointestinal-dysfunction-19058.html

  20. #20 Kathryn
    March 4, 2009

    Wow! Who woulda thought… correlation of A and B doesn’t always imply A causes B or vice versa. Pleiotropic effects of genetic variation can really do some wacky things you wouldn’t expect to share a root cause.

  21. #21 Dr Benway
    March 4, 2009

    Dr. Ornish,

    You’re doing science-based preventive medicine. Prevention and health care maintenance have always been core concerns of medical science. Nothing “alternative” about it.

    So what do you need CAM for?

    Why sit with that army of anti-science quacks on their side of the table when you could be over here with us? (Srsly. Take a look at Weil. Dude knows his way ’round a bong and a sandwich LOL.)

    We try not to lie to the people, even though it might be fun. We don’t like to over-state our data, unless we’re really drunk. We don’t like getting called on our bullshit, but we accept that this might sometimes be necessary for the greater good.

    We are tough. We are rockin’. Chicks dig us!

    So get yer ass over here!

  22. #22 PalMD
    March 4, 2009

    Dr. Ornish, with all due respect, the study you cite sucks ass. It’s a pilot study, no controls, 30 subjects, resting on questionable assumptions. It in no way provides any useful data about lifestyle changes and prostate cancer. All of the subjects had low-risk disease, so it’s unclear what even positive results would mean.

    The 2005 study you cite (J Urol. 2005;174:1065-1070) is almost as useless, in fact the conclusion was very hesitant (“Intensive lifestyle changes may affect the progression of early, low grade prostate cancer in men. Further studies and longer term followup are warranted.”).

  23. #23 PalMD
    March 4, 2009

    Let me just clarify that it is not that the studies suck ass (although they might), it is that the conclusions drawn my Ornish are completely unwarranted and the actual text of the studies are much more cautious than Ornish’s statements. And he pretty much ruins the whole thing when he goes back to Engoresque dualism—even if something is found in follow up studies, it doesn’t mean we are more than matter—in fact, the studies looked at molecular changes, not mystical changes.

  24. #24 Dr Benway
    March 4, 2009

    Dr. Ornish:

    Although you dismiss this statement as “nonsense,” we are, in fact, more than just genes and germs, microbes and molecules.

    Scientific discourse is rule-based. Claims about the world aren’t allowed on the table unless they:
    – can be corroborated
    – might be falsified
    – are phrased using terms with reliable definitions.

    Statements like “we are more than X” would be better phrased, “we are X and Y,” with Y well defined.

    “Read a book” implies Y may be tricky to define. Tricky definitions usually have low inter-rater reliability.

    But “read a book” is a good dodge when your case is weak. It’s up there with, “I must get back to my heavy patient load.”

    BTW, your web site makes me hungry. Right now I’m missing Gordo’s on 9th Avenue near the park.

  25. #25 Dr Benway
    March 4, 2009

    Hmm. I’m noting that there seem to be fewer friendly hand-jobs this side of the table.

    Good science may have its down side.

  26. #26 Orac
    March 4, 2009

    I don’t have time today to do a full response to Dr. Ornish’s unhappiness with me, which probably deserves an entire post of its own. I am, however, flying out to a meeting, and I think I’ll download the articles that he provided me in order to have a little reading material for the flight. If there’s time, I may even bang out a response to his complaint to be posted tomorrow. If I don’t have time, then I’ll try to get to it by Friday.

  27. #27 D. C. Sessions
    March 4, 2009

    Dang. Tough audience.

    Perhaps Dr. Ornish is used to venues with laugh tracks?

  28. #28 Joseph C.
    March 4, 2009

    You might begin by reading some of Leroy Hood’s work (no slouch as a scientist) who described systems biology and the concept of synergy.

    “First of all, never badmouth synergy.”

    -Jack Donaghy, 30 Rock

  29. #29 AnnR
    March 4, 2009

    I see that a Senator from my state, Ms. Mulkuski was there also. I have written her urging her as a representative of Maryland, a state with many medical research facilities, to keep science and rigorous methods at the forefront!

  30. #30 Pierce R. Butler
    March 4, 2009

    Even though NCCAM is incredibly friendly to pseudoscience, it has still failed to “validate” a single alternative medicine. … [Harkin & Co] lash out and try to pressure NCCAM to “validate” more woo.

    Ergo, NCCAM is doing honest work in the face of major political pressure, and deserves acknowledgment and support for its scientific integrity.

    From many of the comments here, including our host’s, it would seem that NCCAM was running prime-time ads about curing HIV with extracts from Mexican apricot pits.

    One negative report from NCCAM about the inefficacy of this year’s snake oil, in the right hands, may persuade more citizens than five apiece in NEJM, Lancet, JAMA, and Skeptical Inquirer. Sacrificing NCCAM to the budget hawks won’t slow down any woo-mongers, but debunkers would come to regret its loss.

  31. #32 Orac
    March 5, 2009

    rgo, NCCAM is doing honest work in the face of major political pressure, and deserves acknowledgment and support for its scientific integrity.

    Wrong:

    http://scienceblogs.com/insolence/2009/02/the_national_center_for_complementary_an.php

    http://scienceblogs.com/insolence/2007/08/governmentfunded_woo.php

    Worse, NCCAM actively promotes CAM by funding fellowships and educational programs.

    I’ll admit that it’s not as bad as it could be. Its directors try to be science-based, but, as I described in the first link, NCCAM by its very design is set up to be as friendly to woo as possible. All it will take is a director who is not a scientist (and, trust me, someday there will be an Andrew Weil-like figure in charge of NCCAM), and even that small amount of scientific respectability is gone.

    In fact, my overall point is that, in spite of a design and culture that is entirely woo-friendly, NCCAM has not been able to “validate” a single “alternative” therapy.

  32. #34 Pierce R. Butler
    March 5, 2009

    …my overall point is that, in spite of a design and culture that is entirely woo-friendly, NCCAM has not been able to “validate” a single “alternative” therapy.

    While mine is that, without NCCAM, would any “alternative” therapy get a solid, thorough, respectable testing?

    Your warning about how one unscientific appointment could push NCCAM over the brink is well-taken – but it supports my point, that so far NCCAM still occupies the high ground.

  33. #35 Dr Benway
    March 5, 2009

    While mine is that, without NCCAM, would any “alternative” therapy get a solid, thorough, respectable testing?

    Pierce, your question indicates that the wool has already been pulled over your eyes.

    Substitute the word “alternative” for the word “unproven.” Unproven therapies are tested all the time. After passing the test, an unproven therapy becomes a proven therapy.

    Yes, cognitive therapies, diet, excercise, sleep habits– all these non-drug things that might impact upon health are studied. They were studied long before the Ministry of Truth known as “CAM” was invented, and doctors remain interested in prevention and lifestyle effects upon health.

    Doctors are not some alien species from PharmaLand. They are just like you! They’d love to figure out simple, low-cost ways to live longer.

    CAM is a trojan horse. It borrowed prevention and lifestyle from traditional medicine to knit itself a coat of respectability. But under that coat you get homeopathy, naturopathy, and pharmaceutical companies eager to escape the expense associated with research, quality control, regulation, and truth in advertising.

    Read my post on NCCAM definitions: “conventional,” “CAM,” “integrative.” God in three persons, blessed trinity.

    The sleight-of-hand used to make the combination of proven and unproven therapies sound legitimate –i.e., “integrative” –would be funny were it not so tragic.

    Yes, our government truly is that stupid and wasteful.

  34. #36 Pierce R. Butler
    March 5, 2009

    Dr Benway – write a bit less condescendingly, please.

    We do not disagree as much as you imply – note that I did not express any surprise or quarrel with NCCAM’s negative results on all their research reported thus far.

    CAM is a trojan horse. … under that coat you get homeopathy, naturopathy, and pharmaceutical companies eager to escape the expense associated with research, quality control, regulation, and truth in advertising.

    Have NCCAM labs produced any reports approving homeopathic or naturopathic products or procedures? Have any drug makers used NCCAM as a bypass around FDA regulations? If so, you’ve got a case – if not, you don’t.

    Meanwhile, it remains that flunking a test from a sympathetic agency will be widely perceived as devastating to a new “therapy” in ways that rejection by another agency (such as the FDA) considered hostile or corrupt never would. Unless they start issuing sloppy or dishonest work, NCCAM is an irreplaceable ally to woo-fighters everywhere.

    Could you direct me to a (layperson-friendly) source to illustrate your claim that “Unproven therapies [beyond new major pharma-corp products] are tested all the time.”?

  35. #37 Dr Benway
    March 5, 2009

    Dr Benway – write a bit less condescendingly, please.

    LOL. I have been shaped by my environment. Or perhaps it’s the rabies.

    Could you direct me to a (layperson-friendly) source to illustrate your claim that “Unproven therapies [beyond new major pharma-corp products] are tested all the time.”?

    How ’bout the sciences known as “clinical psychology” or “nutrition”? Decades of research on non-drug therapies in those domains. You might also check out pharmacognosy if you’re interested in the use of herbal remedies.

    Have NCCAM labs produced any reports approving homeopathic or naturopathic products or procedures?

    After ten years of spending millions studying homeopathy and naturopathy, the NCCAM has come up bust. Yet their web site tarts up homeopathy and naturopathy intriguingly as fonts of Old World wisdom requiring years of study to master. Just a taste:

    - Homeopathy seeks to stimulate the body’s defense mechanisms and processes so as to prevent or treat illness.
    – Treatment involves giving very small doses of substances called remedies that, according to homeopathy, would produce the same or similar symptoms of illness in healthy people if they were given in larger doses.
    – Treatment in homeopathy is individualized (tailored to each person). Homeopathic practitioners select remedies according to a total picture of the patient, including not only symptoms but lifestyle, emotional and mental states, and other factors.

    An honest, non-misleading account of homeopathy would look like this:

    IT’S FECKING WATER!!!!!11!!

  36. #38 Robster, FCD
    March 5, 2009

    Have NCCAM labs produced any reports approving homeopathic or naturopathic products or procedures? Have any drug makers used NCCAM as a bypass around FDA regulations? If so, you’ve got a case – if not, you don’t.

    NCCAM, not so much, but DSHEA has been a boon to big pharma selling unregulatated herbs and supplements under front companies. No need for safety, purity or efficacy under DSHEA, because suddenly herbs, homeopathic placebos and supplements are neither drug nor food. Its a growing 20 billion dollar a year market in the US, and big pharma is a big part of big herbal.

  37. #39 Pierce R. Butler
    March 6, 2009

    Dr Benway – Thanks for the phcog.org link, and for your observations about psychology & nutrition. That said, I still maintain there is a need for well-trained, independent researchers giving “alt” hypotheses a systematic going-over. Even if, as seems likely, they all fail under close examination, such review is much more conclusive than scattered sniping from you, Orac, Randi, et al, combined.

    Last year, I got into a prolonged argument with a friend who tried to get a group we both support to promote a (to me) obvious charlatanry called EFT. It was very frustrating not to be able to locate much about said hustle except spiels from its “practitioners” and snarkasm (which I had already come up with myself) about claims of “quantum mental energies” and the like. A simple double-blind test of EFT’s simplest claims, by NCCAM or any respectable university, would have saved me a great deal of trouble – and what better use of tax funds could there be than that?

    Following your link, I also see a lot of skeptical and ambiguous comments about homeopathy on that same page. It doesn’t bother me that NCCAM describes the claims of homeopathists in public – would you trust the analysis of someone evaluating some piece of research who couldn’t state the hypothesis being reviewed?

    Robster, FCD – as you say, legislative attempts to influence non-prescription treatments are non-trivial, politically fraught, and a separate issue from NCCAM. We can only hope that someone is working on specific studies of outcomes for persons using such treatments – someone independent of the corporations involved and the media/politicians obligated to said corps.

  38. #40 Dr Benway
    March 6, 2009

    We can’t study woo.

    1. Low prior probability means any positive results will almost certainly be false

    2. You can’t reason someone out of a position embraced for irrational reasons. Note that homeopathy is growing in spite of several negative studies.

  39. #41 Pierce R. Butler
    March 6, 2009

    Dr Benway – thanks for another particularly fascinating link.

    Your summary, of course, relies on pre-judging what’s woo & what isn’t (“low prior probability”?), but after a quick (& statistically naive) review I think the take-home points are:

    (a) don’t give much weight to studies based on small samples; and

    (b) Trust empirical papers which test other people’s theories more than empirical papers which test the author’s theory.

    Not all who embrace altie approaches do so for “irrational reasons”, unless within that phrase you include insufficient information.

    Homeopathy thrives in the face of disproof because it has numerous well-motivated marketers, while the debunkers barely reach beyond their own circles. (Yes, I’m sure NCCAM could do more to publicize the existing research – I’m claiming that they’re useful, not that they’re ideal…)

    Please recall that during the infamous dispute between the young Benjamin Franklin and the old Cotton Mather over Jenner’s off-the-wall proposal for interspecies injections, time showed it was the rationalist who was wrong and the superstitionist who was right.

  40. #42 Dean Ornish, M.D.
    March 6, 2009

    Dear Orac,

    I appreciate your thoughtful note and the comments of your readers. Let me first say that, from my perspective, we could all benefit from a little more humility. To me, being dogmatic and demonizing those who don’t agree with us is the antithesis of real science, which values open inquiry, especially of those who challenge the conventional wisdom. As you know, that’s how science progresses.

    Often, breakthroughs in science begin with intuitive leaps, or even dreams-—witness Kekule’s famous dream about a snake swallowing itself that led to understanding the cyclical structure of benzene. Yes, it’s important to test scientifically what can be tested, by as Albert Einstein once wrote, “Not everything that counts can be counted.” Not everything meaningful is measurable.

    As Thomas Kuhn wrote about many years ago in The Structure of Scientific Revolutions, a paradigm provides a model for understanding the way things are. A paradigm can be extremely useful in providing a roadmap to greater understanding, but it can also be limiting when we confuse the paradigm with underlying reality, which is often much more complex than any paradigm can explain.

    When Giodarno Bruno postulated in the 16th century that the earth was not the center of the universe, the Catholic church responded by burning him at the stake. A hundred years later, Galileo showed how people could use a telescope to see for themselves that this is true; he had to recant under threat of the Inquisition, but, by then, it was too late. He gave the world a tool to see the anomalies in the prevailing paradigm.

    Unfortunately, when the limitations of one paradigm become apparent, it is all-too-common for one group either to defend it vociferously—the paradigm provides a sense of order, so criticisms of the limitations of the paradigm are viewed as threatening the order that the paradigm provides. This is the reaction from some of those who comment on your blog. Likewise, there are some in the “alternative medicine” community who, having seen the limitations of science, reject it out of hand. Both are wrong.

    The point of integrative medicine is to integrate the best of traditional science while realizing and broadening its limitations in a thoughtful way.

    For example, you and several of your readers comment that diet, exercise, and yoga-based stress management techniques are not really integrative medicine, they have moved into the mainstream. Well, that’s precisely my point. When I began doing studies 32 years ago, and until relatively recently, these approaches were considered by many in the scientific and medical communities to be radical, stupid, and outlandish. During my internship in internal medicine at Harvard Medical School and the Massachusetts General Hospital in Boston, several of my attending physicians told me what a stupid idea it was that the mind might affect the body, or that the progression of coronary heart disease could be stopped or reversed by making changes in diet and lifestyle.

    As my brother likes to say, “Keep an open mind, but not so open that your brain falls out.” So, yes, be discriminating but not dogmatic; let’s use science to evaluate ideas that might seem a little weird or offbeat, but deciding a priori that an idea is stupid or worthless just because it doesn’t fit the conventional paradigm is, in my humble opinion, the epitome of being unscientific. A little curiosity is a good thing.

    I also find it surprising that you and your colleagues believe that qualifying the results of the studies that my colleagues and I have conducted—e.g., “may” be beneficial–indicates that the studies are not valid. From my perspective, understating one’s findings is prudent since no study is perfect.

    I’m also puzzled by comments about the number of patients in our studies. Judging the quality of a study by the number of patients is a little like judging the quality of a book by the number of words. As you know, the point of science is to determine whether the outcomes of a study are likely due to an intervention or due to random chance. By convention, if the probability is less than 5% that findings are due to chance, then it’s considered statistically significant.

    In our studies, the outcomes were statistically significant even though the number of patients was relatively small. This means that the intervention needs to be powerful enough to show large enough changes, and consistent enough changes, in order to reach a P<0.05 level.

    Part of the problem in conducting studies in areas that are thought impossible is that it’s often hard to get funding to do these studies. It’s often a catch-22: agencies such as NIH are often reluctant to fund studies in areas that they think are impossible or “unscientific,” yet it’s impossible to show something works unless you can raise enough money to study it. While it’s easy to disparage the NCCAM, you and your colleagues should be the ones most vocally supporting it. After all, don’t you want good science to evaluate the claims of those who advocate different modalities of healing? It’s very hard to receive support for doing studies in these areas from other branches of NIH.

    So, let’s have a little less ad hominem attacks and a little more humility and curiosity. To me, that’s good science. We can all learn from each other, but only if we listen instead of attack. It may not be as fun as demonizing others who don’t agree with you, but it’s more likely to lead us to a greater understanding of how things really are.

    Dean Ornish, M.D.
    Founder and President, Preventive Medicine Research Institute
    Clinical Professor of Medicine, University of California, San Francisco
    900 Bridgeway, Suite 1
    Sausalito, California 94965
    phone: 415-332-2525 x222; FAX: 415-332-2588

  41. #43 Dean Ornish, M.D.
    March 6, 2009

    p.s. There is an underlying assumption that most of allopathic medicine is evidence-based, but it is often not.

    For example, the COURAGE trial in the NEJM showed clearly that for patients with stable coronary artery disease (i.e., 90-95% of those who receive angioplasties and stents), they do not prolong life or even prevent cardiac events (http://content.nejm.org/cgi/content/short/NEJMoa070829), yet the incidence of angioplasties and stents has not decreased accordingly. Evidence-based medicine is often supplanted by reimbursement-based medicine.

    So, let’s apply the same scientific standards to all treatments, whatever their origins.

  42. #44 Dr Benway
    March 7, 2009

    Dr. Ornish,

    Quick style comment which will come off as snarky. However I am harmless.

    If talking to an Iraqi muslim, you might avoid any menion of the word “crusade” even as an innocent analogy.

    In talking to African Americans, you might avoid anthropomorphic jokes about monkeys.

    Likewise, in talking to this crowd you might skip references to Kuhn, Galileo, or quantum mechanics. Many here have a conditioned response to these rhetorical props not unlike a compelling wish to drive a spike into one’s own eyeball.

    I made it through Kuhn and Galileo and I’m praying there’s no QM as I return to finish your thoughtful post.

  43. #45 Dr Benway
    March 7, 2009

    …let’s use science to evaluate ideas that might seem a little weird or offbeat, but deciding a priori that an idea is stupid or worthless just because it doesn’t fit the conventional paradigm is, in my humble opinion, the epitome of being unscientific.

    There’s weird and then there is weird.

    Diet and excercise affecting cancer? Plausible.

    Naturopathy? Weird.

    Subluxations? Homeopathy? Delusional.

    MDs selling self-branded supplements? Embarassing.

    Chelation and coffee enemas for kids with autism? Evil.

    I believe you are the plausible wrapping paper surrounding a coalition of crazy, weird, embarrasing, and evil ideas that some want to “integrate” into the universal health care bill.

  44. #46 daedalus2u
    March 7, 2009

    Dr Ornish, as someone who is pursuing a treatment modality that is considered “weird” by some, I have met considerable resistance and have found Thomas Kuhn’s work important in understanding why.

    The use of Kuhn’s work in describing the response to CAM is not apt. Kuhn spoke in terms of scientific paradigms. Scientific paradigms are the fundamental premises that scientists use in their day-to-day work. A paradigm is wrong if (and only if) it does not correspond with reality. A paradigm shift only occurs when the old paradigm is abandoned and the new paradigm is adopted. That only happens when there is a body of data that the new paradigm explains which the old paradigm does not. The new paradigm has to explain all of the data, the old data as well as the new data.

    Kuhn was quite clear, that for a paradigm to be changed there have to be anomalies that the current paradigm does not explain. Before relativity, it was found that the speed of light was the same in all directions. This was experimental data that was completely incompatible with Newtonian mechanics.

    The idea that the mind can not affect the body is obviously wrong and was obviously wrong 50 years ago. Voluntary control of muscle falsifies that idea. Psychogenic stress was known to have adverse effects in humans and in animals. Virtually every part of the body is innervated. Presumably those nerves are doing “something”, or the genes and physiology to support them would not have been conserved over evolutionary time.

    There is no data that the paradigm of science based medicine does not explain. There is no data that the ideas of homeopathy do explain. There is no data that the idea of acupuncture explains. There is no data that the idea of bioenergy fields as in Reiki or chi explains. There is much data that is incompatible with the ideas of homeopathy, acupuncture, Reiki and chi.

    The driving force for CAM is not data looking for explanations; it is providers of CAM trying to get money. There is no data that the paradigm of science based medicine does not explain.

  45. #47 Orac
    March 7, 2009

    Sniff! [wipes away tear]

    I’m so proud of my readers. Dr. Benway, that was classic, and daedelus, that wasn’t too shabby, either. All I can add to it is to see if I can get Dr. Ornish to read an ancient post of mine called The Galileo Gambit, which should explain to him why invoking Galileo in the way he did is almost always the sign of sloppy thinking at the minimum and pushing pseudoscience or quackery at the worst. (I leave it to the reader to decide where on that spectrum Dr. Ornish falls in his response. Personally, I prefer to be generous.) Ditto Kuhn, although I don’t have a quick post to link to.

    At least I should be grateful that Dr. Ornish did not invoke Dr. Ioannidis. However, if there’s anything Ioannidis shows, it’s that testing hypotheses with a very low prior probability based on known science is far more likely to lead to false positives than true positives.

    In any case, once again Dr. Ornish has ignored the larger point. No one is denying that diet and exercise can have a profound effect on health. Nor is anyone saying that the effect of diet an exercise on health shouldn’t be studied. What we are arguing is that you don’t need to associate it with the woo and quackery that goes under the rubrick of CAM, such as reiki, homeopathy, acupuncture, herbalism (while it is true that natural products can be and are often drugs, the spiritualism and vague nonsense about “synergy” is not necessary to study natural products, which is known as pharmacognosy), distance healing, etc. I will point out once again to Dr. Ornish: If you want to be taken seriously as a scientist, you should not yoke your work on diet, exercise, and lifestyle interventions to a heapin’ helpin’ of woo. It makes your work look like woo, pseudoscience, and nonsense by association, even if scientifically it’s good. And you seek out the very association that taints your studies. It’s a huge self-inflicted wound. You must think that there is some huge benefit to cozying up to advocates of dubious therapies that outweighs the hit your scientific reputation takes by doing so.

    I’ll conclude with a few more reasons not to like NCCAM for science:

    Lies, Damn Lies, and ‘Integrative Medicine’

    Prevention—science vs. nonsense

    NCCAM is a victim of its own history

    Tom Harkin’s War on Science (or, “meet the new boss…”)

    Double Standards – Newsweek and Tom Harkin

    Yes We Can! We Can Abolish the NCCAM! (part 2 and part 3)

    The National Center for Complementary and Alternative Medicine (NCCAM): Your tax dollars hard at work

  46. #48 PalMD
    March 7, 2009

    I must say I’m heartened that Dr Ornish reads the good blogs. I feel based on his writings that his motives are probably good, and that if he understands the actual meaning of science based medicine and methodological naturalism, he would be able to put his talents to very good use.

  47. #49 Dr Benway
    March 7, 2009

    So, let’s apply the same scientific standards to all treatments, whatever their origins.

    No disagreement here.

    Your tu quoque is as familiar as Galileo, Kuhn, and QM, in this setting. Typically, it’s used to deflect valid criticism of some study or some practice.

    The implied meaning of the “so’s you!” gambit is, “I’m not cleaning my room until my sister cleans hers.”

    I’d be happier hearing, “Let’s roll up our sleeves and get busy cleaning this place up!”

  48. #50 Dr Benway
    March 7, 2009

    Yes, PalMD. Dr. Ornish is family. In this family, we’re always hearing arguments over the dinner table like, “Now that’s tarting up the data a bit too much there, mate!” Warms the heart and brings a tear to the eye. So much love.

  49. #51 Dr Benway
    March 7, 2009

    I blame a recent concussion for not remembering what I want to say before I hit “post.”

    It’s down to us, this family, to keep the engine of medical science running. We’ve got to embrace the rules and hold each other accountable to them. No one else is up to the task –particularly not US Senators like Harken.

    Let’s not hand over our authority to maintain good scientific standards to the politicians. That road leads to Lysenkoism, intelligent design in science class, and chiropracters as primary care doctors. Such mistakes can take decades to repair.

    Let’s band together and impress the US Congress with our competence at policing ourselves.

  50. #52 Sceptical UK scientist
    March 7, 2009

    Hear hear, Daedalus2u

    It pretty much goes without saying that the scientific community agrees wholeheartedly. For instance, here is an editorial from the (British) Physiological Society’s magazine Physiology News a couple of years back about a change in the UK law that allowed homeopathic remedies to be sold in pharmacies labelled as something like “Traditional ‘Flu Medicine – Homeopathic”

    “The Physiological Society, like other scientific societies, has been asked…to comment on the…[UK Medicines Regulatory Agency’s] decision [to allow the re-labelling of homeopathic remedies as indicated above] and has issued a statement reaffirming its belief in scientific evidence, and decisions based on it.

    The Society’s statement (see below) is not, note, a blanket dismissal of all the things the public commonly regard as complementary therapies. Physiologists have long studied the effects of exercise upon the body, and the physiological actions of plant-derived substances. Work goes on into the possible physiological basis of acupuncture, or the physiological effects of alterations in diet.

    But scientists want evidence, not anecdotes and hand-waving. If proper science shows real physiological effects, beyond those of a placebo compound or sham intervention, and if these can be made to work as a treatment, what you have is a therapy. Rather than being a question of ‘alternative’ or ‘mainstream’, it is down to what works – or more precisely, what we can be sure works because it can be shown to work in a properly-designed scientific experiment”

    – full article here.

    And the Physiological Society statement itself:

    ‘The Physiological Society is concerned with the scientific investigation of how the body works … It is our view that “alternative medicine” has, with very few exceptions, no scientific foundation, either empirical or theoretical. As an extreme example, many homeopathic medicines contain no molecules of their ingredient, so they can have no effect (beyond that of a placebo). To claim otherwise it would be necessary to abandon the entire molecular basis of chemistry. The Society believes that any claim made for a medicine must be based on evidence, and that it is a duty of the regulatory authorities to ensure that this is done.’

  51. #53 daedalus2u
    March 7, 2009

    Orac, it always enormously irritates me when people who are wrong try to use the Galileo gambit. First because they are wrong, second because ignorant people saying you are wrong is not evidence that you are right, third because if anyone should be using the Galileo gambit it should be me with my nitric oxide bacteria ;) (which is consistent with everything that is known), not crap like homeopathy which has been wrong for 200 years.

    Your point about not becoming associated with woo is apt. That is one of the reasons I have tried to collaborate only with science based researchers and not quacks. My fear is that they will try to hook their woo to my science.

    Dr Benway, be careful with that concussion, hemoglobin in the CSF does cause oxidative stress and neuroinflammation which reduces NO levels. You want to resolve that ASAP so it doesn’t become chronic. I think that neuroinflammation becoming chronic is the mechanism for the “brain fog” that some conditions produce. I think that treatments like fever therapy (which is an extreme treatment that should not be tried at home) ultimately worked by resolving neuroinflammation. I think that is how Etanercept resolves the symptoms of Alzheimer’s too (that is an extreme treatment too).

  52. #54 Dean Ornish, M.D.
    March 7, 2009

    I thought this might be a forum for rational discourse, but I was wrong. In the name of defending science– the science I love is curious, inquisitive, and unfettered by a priori certainty of what is true and what is not– you are astonishingly dogmatic, arrogant, patronizing, mean-spirited, and narrow-minded.

    You write, “once again Dr. Ornish has ignored the larger point. No one is denying that diet and exercise can have a profound effect on health. Nor is anyone saying that the effect of diet an exercise on health shouldn’t be studied. What we are arguing is that you don’t need to associate it with the woo and quackery that goes under the rubrick of CAM, such as reiki, homeopathy, acupuncture, herbalism…”

    You seem to have been so eager to react that you haven’t responded to my main point: the diet and exercise that you now think are now acceptable to study and are no longer woo and quackery were considered not acceptable to study and considered as woo and quackery by many of your colleagues at the time, if not by yourselves.

    Just because something doesn’t fit within an accepted theory or construct or paradigm doesn’t mean it’s not worthy of scientific study. Many of the real breakthroughs in science fall into that category (I didn’t realize that citing Kuhn or Galileo was going into engender such a knee-jerk response, “oh there you go again…”). To me, that’s what makes it worth studying, especially when many people are already using these approaches. As you probably know, more money is spent out of pocket on “alternative” medicine than “traditional” medicine.

    I’m surprised that you aren’t the most vociferous champions of using rigorous science to study approaches that millions of people are using.

    Perhaps you’re more interested in making yourselves feel important by putting down others you think are not as intellectually pure and perhaps morally superior. And, yes, there are some in the CAM world, and, for that matter, in all parts of the world, who are like that, and I say the same to them as well.

    As I said, we can all benefit from a little humility. Bye.

  53. #55 PalMD
    March 7, 2009

    Perhaps Dr. Ornish has forgotten, or never knew, or is ignoring, the fact that homeopathy et al have already been studied and disproved (despite their implausibility). How many times, Dr. Ornish, do we need to study magic water and find it wanting before we pour it down the drain?

  54. #56 Orac
    March 7, 2009

    Dr. Ornish,

    I figured you wouldn’t understand, but, on the off chance that you see this, let me put it this way. The modalities that I have labeled as “woo,” and the ones to which you are cozying up have been studied. Moreover, for many of them to be true (homeopathy or “energy healing,” for instance), large swaths of currently understood science would have to be not just wrong, but spectacularly, unbelievably wrong. I suppose that’s possible, but the problem is, when new scientific hypotheses turn into new scientific theories, supplanting old theories, the new theories still must account for previous knowledge. In fact, they must account for the new observations that cast doubt on the previous theory and all the old observations that supported it. Einstein’s theory of relativity, for instance, reduces to Newton’s laws at velocities that are very small in comparison to the speed of light, thus accounting for both Newton’s laws (which approximate relativistic predictions well at low velocities) and the new observations that Newton’s laws couldn’t account for. My point is that there have been no observations about any of these “alternative medicine” modalities compelling enough to call current scientific understanding of biology and disease into question as dramatically as the observations that led to, for instance, the theory of relativity and then later to quantum mechanics, called into doubt classical mechanics. Until that happens, it’s hard to justify putting a huge effort into studying things like homeopathy or “energy healing.”

    Zeroing in on homeopathy, for instance, you recently wrote an editorial for the WSJ with Andrew Weil, Deepak Chopra, and Rustum Roy. Rustum Roy, as I presume you know, is one of the foremost boosters of homeopathy. Indeed, a colleague of mine once debated him. Homeopathy is quackery, period. It involves a principle that is unscientific (“like cures like”) and the dilution of substances many orders of magnitude more than Avagadro’s number, so that the odds against even a single molecule remaining are overwhelming. Moreover, they claim that their remedies must be “potentized” by vigorous shaking (succussion) between each serial dilution. Indeed, it is claimed by homeopaths, that without succussion, their remedies will not work.

    Do you think there is anything to homeopathy? If so, why?

    You see, the difference between diet and exercise compared to homepathy, for example, is that there are many plausible potential mechanisms by which diet and lifestyle could impact disease. There is no even remotely plausible mechanism by which homeopathy may work, and, indeed, the sum total of the clinical trials done on homeopathy thus far (and there are many) is entirely consistent with homeopathy being nothing more than a placebo. Effects found in smaller, less rigorous trials disappear in bigger, more rigorously controlled randomized trials.

    You, sir, by cozying up to homeopaths and other supporters of quackery, have either wittingly or unwittinly linked a reasonable scientific hypothesis (that diet can reduce the risk of disease and even in some cases treat it) to total pseudoscience (homeopathy, etc.). Moreover, your example claiming that diet and exercise were not considered mainstream is simply not true. It can be argued that scientific medicine has underemphasized lifestyle interventions, but it has not labeled them as “alternative.” CAM advocates have as a strategy to appear to be an “outsider.” In any case, the answer to that is to provide science- and evidence-based lifestyle modalities and get physicians to emphasize them.

    Finally, the reason we all get upset at the use of the Galileo Gambit is because, whether you know it or not, it’s a favorite gambit of quacks. As Michael Shermer once said: “Heresy does not equal correctness.”

    My favorite quote about this issue has been attributed to many people and exists in many variations, but it goes:

    They laughed at Copernicus. They laughed at the Wright brothers. Yes, well, they also laughed at the Marx Brothers. Being laughed at does not mean you are right.

    I usually insert “The Three Stooges,” although some prefer Bozo the Clown.

    In the end, your accusation of close-mindedness just doesn’t hold water. Show me the compelling data, and I will change my mind–even if it’s about something as scientifically ridiculous (now) as homeopathy. Show me the data. Until “alternative medicine” can do that, “integrating” pseudoscience with scientific medicine is a recipe for disaster.

    Finally, I notice that you mention that CAM modalities require more cash out of pocket. Well, exactly. The beauty of CAM is that there’s no nasty mucking around with insurance companies. It’s all cash on the barrelhead, without all that nasty paperwork and annoyance (other than credit card slips, of course).

  55. #57 has
    March 7, 2009

    Could someone please phone for a whaaambulance? Dr. Ornish just tripped on his cloak.

  56. #58 khan
    March 7, 2009

    In some places, the dramatic exit is referred to as ‘flouncing’.

  57. #59 gaiainc
    March 7, 2009

    I don’t understand why this concept is so hard to get, but it seems even Dr. Ornish doesn’t get it (it also seems that he still smarts from his comments from attendings at MGH; they were asses, get over it and yourself please). Practice changes in medicine because good data from good studies changes medicine. Period. There is NO good data from any good studies that homeopathy, acupuncture, naturopathy, or any other brand of woo does anything more than placebo. None. Zip. Zero. Nilch. Nada. Even NCCAM has come up with nothing. Beejeebus. Spending money to study something that’s already shown to not work is stupid, wasteful, and disrespectful of the average taxpayer.

    As for out of pocket costs, so what? What kind of argument is that? People spend thousands out of pocket for Botox or breast implants or turning themselves into cats? Does that mean we all should be doing this? I don’t think so. Just because people spend thousands or millions or billions of dollars on something doesn’t mean that it is right or proper or anything. It just means that someone has spent more money. Higher cost does not mean better. Just look at generics versus brand name medications.

    Un-fricking-believable.

  58. #60 Dr Benway
    March 7, 2009

    Dr. Ornish:

    …the diet and exercise that you now think are now acceptable to study and are no longer woo and quackery were considered not acceptable to study and considered as woo and quackery by many of your colleagues at the time, if not by yourselves.

    Really? I could list the names of teachers who taught me cool stuff about diet and excercise in the 1980s. I remember no stigma there. In fact John West, who did a lot of work on the long term effects of hypoxia among Mt. Everest climbers, seemed like kind of a rock star to me.

    …the science I love is curious, inquisitive, and unfettered by a priori certainty of what is true and what is not

    But you draw an a priori line somehwere. You must.

    For example, if I were to say that bilateral enucleation can reduce the painful symptoms of gout, I doubt you would reply, “We can’t rule it out!”

  59. #61 Dr Aust
    March 7, 2009

    Hmmm. Reading Dean Ornish’s last comment before the spectacular flounce-out, and in particular the line Dr Benway quoted, recalls the old saying:

    “It’s good to keep an open mind… …just not so open that your brain falls out”

  60. #62 Dr Benway
    March 7, 2009

    Dr. Ornish:

    As I said, we can all benefit from a little humility.

    Oh pshaw.

    Once you bond with the rough-and-tumble gang, you can’t imagine toddling back to the safer world where no one says anything “not nice.”

    I treasure my experiences of being wrong. They’ve been my greatest teachers.

    A human being surrounded by yes-men and feigned respect slowly evolves into an unbearable, Tom Cruise-like curiosity.

  61. #63 Joseph C.
    March 7, 2009

    I thought this might be a forum for rational discourse, but I was wrong. In the name of defending science– the science I love is curious, inquisitive, and unfettered by a priori certainty of what is true and what is not– you are astonishingly dogmatic, arrogant, patronizing, mean-spirited, and narrow-minded.

    Sorry Dr. Ornish, but it’s you and your fellow CAM supporters that are close-minded. CAM treatments fail in study and after study, but you’re just not open-minded enough to listen to the evidence. Sorry we held you to a high standard rather than fawn over you for stickin’ it to da man. Sorry that your anecdotes about cranky old MGH attendings during the Carter Administration failed to convince us of a prior medical conspiracy against diet and exercise.

  62. #64 JCmacc
    March 8, 2009

    What Dr Ornish has demonstrated in this thread is that he really doesn’t understand anything about the scientific method. To me there’s a solid general rule for spotting woo from genuine but otherwise weird science and that’s the starting point.

    Real science has to start with something, even science with seemingly weird concepts. There has to be a testable and repeatable observation that requires a hunt for a totally new mechanism to explain it (think the electron beam scattering studies that required bizarre quantum explanations) or a known mechanism that would predict for a so far unobserved finding (think of the predictions from the Big Bang theory that led to the much later measurements of cosmic background radiation).

    The Cargo-Cult version of science Dr Ornish wants us to be “open minded” about abandons the need for a real starting point. This to me is the exact spot where “open-mindedness” can now be defined as “so open minded your brain falls out” to repeat an earlier point.

    As Orac discusses higher up the thread, homeopathy has no testable and repeatable efficacy that requires us to seek a new mechanism nor does its proposed mechanism fit with current laws of biology, chemistry and physics in a way that justifies looking for a novel outcome. Homeopathy has no genuine science as there’s no starting point.

    With the above in mind, Dr Ornish is revealed for what he is – a Cargo Cult scientist. He’s chasing an unknown mechanism for an unobserved effect. That is not science. Nobody is required to keep an open mind about Cargo Cult science regardless of how much Ornish immodestly compares himself to Galileo.

  63. #65 AtheistAcolyte
    March 9, 2009

    It would seem that Dr. Ornish is suggesting that CAM is needed so that “integrative medicine” can join the mainstream of medical treatment, just as his diet and exercise had to cross over a line from perceived woo into the mainstream in its day.

    One must wonder, then, if diet and exercise can make that trial by fire, why other “integrative medicines” must have a fast track through CAM. Why can’t they take the long road, too? I maintain that it’s better to wait a few years for a treatment to become mainstream than to waste money on a fast-tracked trick-or-treatment today.

  64. #66 T. Bruce McNeely
    March 11, 2009

    Dr. Ornish says: “the diet and exercise that you now think are now acceptable to study and are no longer woo and quackery were considered not acceptable to study and considered as woo and quackery by many of your colleagues at the time, if not by yourselves. ”

    Bull. Complete and utter bull.

    I graduated in medicine in 1974 (yes, 35 years ago), and diet and exercise were considered mainstays in the prevention and treatment of coronary artery disease back then. There were many studies being done on the effects of diet and exercise (Framingham study, for example?).
    Some of the advice was controversial, and some has since been proven wrong, or at least oversold. But, hey, that’s how science works. However, to say that lifestyle approaches were considered quackery and woo is, in my opinion, delusional.

  65. #67 Prometheus
    March 11, 2009

    Dr. Ornish says:

    “…the diet and exercise that you now think are now acceptable to study and are no longer woo and quackery were considered not acceptable to study and considered as woo and quackery by many of your colleagues at the time, if not by yourselves.”

    This is the classic fallacy of equivocation. Dr. Ornish implies that “diet and exercise” were at one time considered “woo” (or “quackery”, if you wish), but neglects to mention the context in which they were (and are) considered such.

    Good diet and moderate exercise were considered “healthful” as far back as 1500 BCE (and probably even earlier). There is no controversy about this and nobody seriously doubts today that good diet and moderate exercise are important for everybody’s health.

    Where we part company is with the idea that the “proper” diet and exercise can “cure”, “prevent” or “influence” things like cancer. While poor nutrition probably worsens the eventual outcome in cancer, HIV and other disorders, there is sparse data supporting the claims – made by Dr. Ornish and others – that “proper” diet (beyond adequate nutrition) and exercise can influence the course of these disorders. Simply stating it as if it were a “proven” fact – as Dr. Ornish does – is incorrect.

    This is a common tactic by “CAM” promoters. Since “everybody knows” the importance of a good diet and exercise for “good health”, it is a simple step to convince scientifically unsophisticated people that the “proper” diet and exercise can lead to “optimum health”. Or, that the “proper” diet and exercise can turn “bad health” unrelated to poor nutrition or lack of exercise (e.g. cancer) into “good health”.

    I’m sorry if Dr. Ornish’ feelings got hurt by our skepticism (actually, I’m not sorry), but he needs to realize that the folks who read this ‘blog are not like the audience on the Oprah show. His arguments are unconvincing and his chiding is childish and petulant. His arrogance and closed-mindedness show in his inability to even consider that he just might be wrong.

    Grow up, Dr. Ornish. Learn how to do science and come over to the winning side.

    Prometheus

  66. #68 Dr Benway
    March 11, 2009

    Dr. Ornish could redeem himself by articulating his standard for deciding which claims merit study and which do not.

    Saying, “nothing should be off the table a priori” makes no sense. No one could live by such a rule.

    Whatever the rule, it must fulfill the categorical imperative. It must be phrased in such a way that we’re content when it applies to our own research as well as to research by others using public funds, which are not limitless.

    Whatever the rule, it ought to filter out batshit like, “cow urine reduces the symptoms of autism.”

  67. #69 daedalus2u
    March 11, 2009

    Dr Benway, when you attempt to choose a treatment modality that you think is obviously wrong, don’t choose one that involves nitric oxide ;) Bat shit (provided it is inoculated with ammonia oxidizing bacteria (a virtual certainty in the wild) is likely to be an excellent source of NO. Bat shit, or guano has a lot of urea in it as well as chitin from undigested insects, and would be expected to behave much the same as chicken manure. Chickens are uricotelic animals; the uric acid they excrete makes their urine white and semi-solid. I have good data demonstrating that aerobically composted chicken manure is an excellent NO source.

    http://viewmorepics.myspace.com/index.cfm?fuseaction=viewImage&friendID=31529065&albumID=320559&imageID=511789

    This data was collected using 10 grams of dry composted chicken manure called by the trade name Cockadoodle DOO.

    http://www.purebarnyard.com/cockadoodledoo/

    When water was added, the moisten material immediately began producing NO at a high and sustained rate. This rate is high enough to produce local (and very likely systemic) NO mediated effects. When 10 grams of CDD was placed in a 60 mL glass vial and moistened, the headspace of the vial produced a very high NO level, some hundreds of ppm NO. The analyzer I used (Seivers NOA 280i) only measures NO, it doesn’t measure NO2. NO is easily oxidized to NO2 by air, I think it is likely that the head space had lethal quantities of NO2. It is easy to smell NO2 coming off CDD. In a confined space that could easily be fatal (as is not uncommon in silos, where NO2 from bacterial action in silage has killed many farmers).

    Cow urine is an excellent source of urea and perhaps nitrate (depending on the nitrate content of the fodder). If cow urine were inoculated with ammonia oxidizing bacteria, it too would become an excellent source of NO.

    So what does this have to do with autism? I happen to subscribe to the hypothesis (my own) that autism is caused by low NO, and that raising NO levels will shift individuals on the autism spectrum in a more social direction. As a source of NO, cow urine (provided it was inoculated with the right bacteria) should improve autism symptoms. I go into some of the details of that hypothesis on my blog. Some of the behaviors and traits of ASDs are due to the neuroanatomy, the details of which are fixed in utero and which is to some extent immutable. No treatment can change that neuroanatomy and make someone who is ASD to be NT. However raising NO levels does improve some behaviors of some individuals with autism (Zimmerman AW, Pediatrics 2007). I have a very extensive blog discussing the physiology of how that works.

    No one should go out and try using bat shit, chicken manure or cow urine to try and treat autism (without doing a real clinical trial). But I think any of them would work significantly better than chelation, HBOT, Lupron, or a zillion supplements (which don’t work at all).

  68. #70 Dr Benway
    March 11, 2009

    daedalus, I now rely upon you for the nitrous angle in any controversy.

    When I used to wait tables, sometimes the whipped cream would come out of the cans all runny. Some of the other wait staff would take the cans out back and huff out the nitrous for the head rush. All well and good, but putting the cans back in the fridge was lame.

    Just thought I’d share.

  69. #71 daedalus2u
    March 12, 2009

    Dr Benway, nitrous oxide is N2O, and is completely different than nitric oxide NO. N2O is pretty inert and is a not so good inhalation anesthetic. NO is pretty reactive and is the signaling molecule used in many thousands of pathways in physiology. People have breathed air containing hundreds of ppm NO with no ill effects. Your nasal passages produce NO resulting in a few hundred ppb NO in the air that reaches your lungs. This matches the perfusion of blood with the supply of air. Inhaled NO is used in premies. The NO is consumed by oxyhemoglobin before the blood leaves the lung, so there are no systemic NO effects from inhaled NO. When the nasal passages are occluded, the NO level can reach 20 ppm. NO is odorless.

    Nitrogen dioxide, NO2 is quite toxic. The TLV is a few ppm. It has a strong smell, oxidizing like chlorine but sweeter. It is a brown gas, and is the reason that plumes from power plants appear brown.

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