Respectful Insolence

I’ve made no secret about the fact that I am not a fan of the National Center for Complementary and Alternative Medicine (NCCAM). I consider it a useless, redundant center within the National Institutes of Health because it does nothing that could’t be done as well or better in the institutes and centers of the NIH that existed before woo-friendly Senator Tom Harkin (D-IA) created NCCAM’s precursor and then saw to it that it grew to a full center, with a budget in the $125 million a year range. Personally, if something has to be cut fromt the government in this time of fiscal austerity, I couldn’t think of any better place to start in the NIH than to eliminate NCCAM. True, it’s only about 0.5% of the NIH budget, but that would be 0.5% that could be saved for real science. In these times of pay lines at the 7th percentile range (yes, that’s what I’ve been hearing from my colleagues in the study sections), every little bit helps, particularly if we could get rid of the National Cancer Institute’s Office of Cancer Complementary and Alternative Medicine as well, which has the most inappropriate acronym ever (OCCAM). OCCAM has a budget on par with that of NCCAM; so if we could eliminate them both that would save 1% of the NIH budget without losing any detectable scientific progress.

I bring all this up because last week NCCAM released its five year strategic plan for 2011 to 2015.

Truly, it’s a case of The Good, The Bad, and The Ugly. Either that, or: We were only kidding before. Now, let’s do some real science. Really. I’m not kidding anymore. And, no, I promise not to pull the football away before you kick it, Charlie Brown.

The Good (more accurately: The Least Bad)

Let’s start by listing the goals of the NCCAM Strategic Plan 2011-2015:

  • GOAL 1: Advance the science and practice of symptom management.
  • GOAL 2: Develop effective, practical, personalized strategies for promoting health and well-being.
  • GOAL 3: Enable better evidence-based decision making regarding CAM use and its integration into health care and health promotion.

To accomplish these goals, NCCAM proposes five Strategic Objectives:

As much as I detest NCCAM as a political tool foisted upon the NIH by quackery-friendly legislators, in particular Senator Tom Harkin (D-IA), even I have to admit that there is some good in NCCAM’s strategic plan, specifically Objective 4: Improve the Capacity of the Field To Carry Out Rigorous Research. If you’re a scientist, arguing against improving the capacity to do rigorous science is akin to arguing against mom and apple pie; no serious scientist would do it. Of course, implicit in this NCCAM objective is an admission that the CAM research NCCAM has tended to fund in the past has not been very good, and, worse, it is very telling that NCCAM should even find it necessary to make improving the quality of its funded research a strategic objective. After all, improving the the capacity of a field to carry out rigorous research should be part of the mission of every NIH institute and center, so much so that it should almost go without saying. Unfortunately, how NCCAM proposes to go about improving the scientific rigor of its work isn’t exactly the way it should go about improving the scientific rigor of its work. For example, one key method proposed by NCCAM is to “support a variety of high-quality research training and career development opportunities to increase the number, quality, and diversity of CAM researchers”:

A successful and robust CAM research enterprise must draw from two sources of well-trained, skilled, and experienced talent: CAM practitioners expert in their respective disciplines and biomedical/behavioral scientists expert in cutting-edge scientific methods. CAM practitioners are the key holders of knowledge related to the potential application of CAM interventions and disciplines. NCCAM has always recognized the need for research training and career development efforts targeted specifically toward this diverse community. Over the years the Center has developed a number of programs aimed at enhancing CAM practitioners’ abilities to critically evaluate biomedical literature, participate in clinical research, and, in some cases, seek advanced training and career development opportunities for careers in the field of CAM and integrative medicine research.

All of this sounds very nice, but where the rubber meets the road, what this means is listening to reiki practitioners, acupuncturists, therapeutic touch practitioners, and homeopaths (in other words, believers in unsupported modalities based on magical thinking) when setting priorities, in addition to listening to less unreality-based CAM practitioners, such as herbalists or even chiropractors who stick with musculoskeletal disorders and don’t claim that chiropractic can cure asthma or other unrelated diseases. Using such practitioners to set research priorities and to collaborate with real scientists is what Harriet Hall would call Tooth Fairy science. It’s putting the cart before the horse. Implicit in this strategy is the assumption that there is an actual phenomenon to be studied in modalities like reiki, which, let’s face it, is nothing more than faith healing stripped of its Christian religious background and replaced with Eastern mysticism. If I knew that NCCAM was in actuality trying to determine whether these phenomena exist, rather than “how” they work, perhaps I’d be less critical. Another part of me can’t help but note that trying to suck real scientists into the study of pseudoscience, NCCAM is blatantly trying to cloak various modalities in the mantle of scientific respectability before they deserve to wear it.

Whether I’m being cynical or realistic I leave to the reader to judge. Certainly, given that Objective 3 (Increase Understanding of “Real-World” Patterns and Outcomes of CAM Use and Its Integration Into Health Care and Health Promotion) seems custom-designed to develop a case for “integrating” CAM into science-based medicine, rather that determining which modalities actually have some utility supported by science and therefore should cease being “alternative” and become just “medicine.”

Less irritating is Strategic Objective 2: Advance Research on CAM Natural Products. Actually, it’s not so much “good” as least objectionable and even somewhat scientifically defensible. Here are the strategies proposed by NCCAM:

Strategy 2.1: Harness state-of-the-art “omics” and other high-throughput technologies and systems biology approaches of the sciences of pharmacology and pharmacognosy to:

  • Elucidate biological effects, mechanisms of action, and safety profiles of CAM natural products
  • Study interactions of components with each other and with host biology
  • Build a solid biological foundation for translational research needed to carry out clinical studies.

Strategy 2.2: Support translational research to build a solid biological foundation for research on CAM natural products to:

  • Develop and validate sensitive and reliable translational tools to detect and measure mechanistically relevant signatures of biological effect and to measure efficacy and other outcomes
  • Conduct preliminary/early phase studies of safety, toxicity, dosing, adherence, control validation, effect/sample sizes, ADME (absorption, distribution, metabolism, and excretion), and pharmacokinetics
  • Build upon established and proven product integrity policies and processes.

Strategy 2.3: Support targeted large-scale clinical evaluation and intervention studies of carefully selected CAM natural products.

Of course, the reason that I label this as being part of “the good” is because, of all the aspects of CAM, natural products represent the area with the most scientific plausibility. On the other hand, it’s hard not to point out that there is nothing here that natural products pharmacologists haven’t been doing for decades. Nothing. What NCCAM is in essence describing is nothing more than pharmacogonosy, the study of natural products pharmacology. It’s the sort of thing that our very own David Kroll does. It’s the sort of thing that thousands of pharmacologists do every day. Heck, it’s even the sort of thing that a lot of pharmaceutical companies do when they try to isolate drugs from natural products. There are many examples of drugs that have come from natural products, including taxol (Pacific Yew tree); vinca alkaloids (periwinkle plant); related drugs like campothecin, irinotecan, and topotecan (Camptotheca acuminata, a.k.a. Happy tree); and, of course, aspirin. The list is extensive, arguably longer than the list of synthetic drugs.

In fact, what NCCAM is doing here, whether Dr. Briggs realizes it or not, is the classic “bait and switch” that I discussed when kvetching about Dr. Oz’s promotion of various Ayruvedic medicines and “detox” diets. In essence, NCCAM has claimed for itself all of natural products pharmacology as being “CAM.” The difference is that there is a layer of belief slathered on it, specifically the CAM belief that somehow the natural plant is superior to purified components or molecules found to have medicinal value. The assumption is that the mixture of unpurified compounds somehow allows the components in the plant or natural product to be “synergistic.” While this sort of synergy is possible, it is actually pretty implausible, with precious few examples known. Worse, it’s very hard to demonstrate true synergy between only two or three components, much less the hundreds — or even thousands — of components in many plants used in CAM. In reality, for all practical purposes and even when a plant does have an active compound (or active compounds) in it that function as a drug, using whole plant extracts, as most CAM practitioners do, substitutes adulterated active ingredients whose purity and potency can vary wildly for well-characterized, predictable, purified active drug.

Actually, I don’t mind this sort of research so much, as long as it’s testing hypotheses that are supported by sound basic science and preclinical data. Certainly, that’s what NCCAM appears to be trying to do, and if NCCAM can’t be dismantled (as I would prefer), its components absorbed into the appropriate institutes and centers of the NIH, then I suppose this is the sort of research that is least likely to cause harm and might actually produce useful results, far more so than much of the rest of the research that NCCAM funds. However, I continue to question why such research should now be considered “CAM” when natural products research has long been a major area of “conventional research.” After all, the study of natural products and herbs with useful pharmacological activity has been an active area of research in pharmacology since time immemorial. There’s no scientific rationale why such studies should be segregated away as “alternative”; they could and should be evaluated just like any other scientific study. Worse, trying to segregate natural product pharmacology at NCCAM devalues pharmacognosy, and by association with the other woo (see below) also being funded under the rubric of “CAM” makes it look like woo too.

In fact, the entire set of goals set forth by Dr. Briggs in the introduction are a “bait and switch.” Notice how two out of the three of these have nothing to do with CAM. Seriously. Why is it that symptom management is CAM? Take the example of oncology. Considerable research and effort go into trying to develop strategies to minimize the effects of therapy. A whole branch of anesthesiology is devoted to the management of chronic pain. If that’s not “symptom management,” I don’t know what is. So what does CAM bring to the science and practice of symptom management? Very little, I would argue, that can’t be studied outside the context of CAM. Unfortunately, what CAM really does bring to symptom management is pseudoscience and prescientific ideas of how the body works. It brings qi. It brings human energy fields. It brings vitalism. Do we really need to “integrate” nonsense with science in symptom management? Perhaps NCCAM can help us understand placebo effects better, for example, but that is research that can and should be the bailiwick of other NIH institutes and centers.

And don’t get me started on Goal 2, which, similarly, is a province of science-based medicine. One might argue that medicine hasn’t done as good a job of developing personalized strategies to promote health and well-being, but the solution to that problem is to emphasize such strategies more in science-based medicine, not to bring in pseudoscience.

The Bad and The Ugly

Let’s take a look at all the strategic objectives. I only discussed Strategic Objective 2 above, but that’s just because I wanted to discuss the least objectionable objective. Actually, in and of itself, Strategic Objective 2 is not objectionable. After all, natural products pharmacology is something I consider fascinating. So here are the five Strategic Objectives in the NCCAM Strategic Plan 2011-2015. Neither would Objective 4 be objectionable if the science were truly rigorous and subject to analyses of Bayesian prior probability before highly improbable modalities like homeopathy or reiki are tested in human beings.

So let’s look at Strategic Objective 5 (Develop and Disseminate Objective, Evidence-Based Information on CAM Interventions). These sound rather benign, don’t they? I mean, who could argue with disseminating “objective, evidence-based information on CAM interventions,” for example? Certainly not me. And I actually do hope that NCCAM does do that, that it really is serious about it. If so, it would tell people that homeopathy is nothing but water, that there is no evidence that reiki practitioners can manipulate a “universal energy field” to heal, and that there’s no scientifically convincing evidence that practitioners of therapeutic touch practitioners can detect or manipulate human energy fields. Let’s look at the key points NCCAM emphasizes about reiki:

  • People use Reiki to promote overall health and well-being. Reiki is also used by people who are seeking relief from disease-related symptoms and the side effects of conventional medical treatments.
  • Reiki has historically been practiced as a form of self-care. Increasingly, it is also provided by health care professionals in a variety of clinical settings.
  • People do not need a special background to learn how to perform Reiki. Currently, training and certification for Reiki practitioners are not formally regulated.
  • Scientific research is under way to learn more about how Reiki may work, its possible effects on health, and diseases and conditions for which it may be helpful.
  • Tell your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

Pointing out:

Reiki is based on the idea that there is a universal (or source) energy that supports the body’s innate healing abilities. Practitioners seek to access this energy, allowing it to flow to the body and facilitate healing.

Although generally practiced as a form of self-care, Reiki can be received from someone else and may be offered in a variety of health care settings, including medical offices, hospitals, and clinics. It can be practiced on its own or along with other CAM therapies or conventional medical treatments.

I could provide other examples, such as the entry on NCCAM for Ayruvedic medicine. However, perhaps the most instructive example is the entry for homeopathy. A truly science-based assessment of homeopathy would point out that the principles of homeopathy violate multiple well-established laws of physics and chemistry and that, for homeopathy to work, these well-established laws would have to be found not to be just wrong, but spectacularly wrong. It would also point out that, for that to happen, the amount of evidence in support of homeopathy would have to start to approach the level of evidence that tells us that homeopathy can’t work. While NCCAM does concede that homeopathy is “controversial” and that its tenets violate known laws of physics, it does so in a weaselly, wishy-washy way:

Homeopathy is a controversial area of CAM because a number of its key concepts are not consistent with established laws of science (particularly chemistry and physics). Critics think it is implausible that a remedy containing a miniscule amount of an active ingredient (sometimes not a single molecule of the original compound) can have any biological effect–beneficial or otherwise. For these reasons, critics argue that continuing the scientific study of homeopathy is not worthwhile. Others point to observational and anecdotal evidence that homeopathy does work and argue that it should not be rejected just because science has not been able to explain it.

Three of its “key points” about homeopathy are:

  • The principle of similars (or “like cures like”) is a central homeopathic principle. The principle states that a disease can be cured by a substance that produces similar symptoms in healthy people.
  • Most analyses have concluded that there is little evidence to support homeopathy as an effective treatment for any specific condition; although, some studies have reported positive findings.
  • There are challenges in studying homeopathy and controversies regarding the field. This is largely because a number of its key concepts are not consistent with the current understanding of science, particularly chemistry and physics.

Yes, NCCAM presents a classic “tell both sides” false equivalence argument. On the one hand, established laws of science tell us homeopathy can’t work. On the other hand, anecdotal evidence tells us it does work and therefore we should study it. Never mind that the two principles upon which homeopathy is based (“like cures like” and the law of infinitesimals) have no real basis in science, particularly the law of infinitesimals, which states that diluting and succussing a remedy to the point where not a single molecule is likely to remain somehow makes it stronger.

This brings us to the meanest, ugliest, nastiest one, the meanest Strategic Objective of them all, Strategic Objective 1 (Advance Research on Mind and Body Interventions, Practices, and Disciplines). Personally, I find it telling that this is Objective 1 on the list, and NCCAM even lists examples of CAM mind-body interventions:

  • Acupuncture
  • Breath practices
  • Meditation
  • Guided imagery
  • Progressive relaxation
  • Tai chi
  • Yoga
  • Spinal manipulation
  • Massage therapy
  • Feldenkreis method
  • Alexander technique
  • Pilates
  • Hypnosis
  • Trager psychophysical integration
  • Reiki
  • Healing touch
  • Qi gong
  • Craniosacral therapy
  • Reflexology

Here’s the “bait and switch” again. If NCCAM had restricted itself to modalities that, right or wrong, fall under “mind-body” interventions, such as meditation, guided imagery, breathing practices, hypnosis, and the like, I would have had little problem with proposing to study them as a major strategic initiative of NCCAM. Unfortunately, that’s not what NCCAM did. Notice how NCCAM also throws in there all manner of pure quackery, such as reiki, healing touch, craniosacral therapy, and even reflexology. Seriously, reflexology! You know, the idea that every organ and part of the body “maps” to parts of the foot or hand, an idea that is not supported — and, in fact, is contradicted — by what we know about human anatomy and physiology. Placing these forms of quackery next to forms of interventions such as guided imagery that could well turn out to be science-based and useful implies, either wittingly or unwittingly, that “mind-body” interventions already known to be quackery are somehow worthy of study. Also note how NCCAM includes modalities like Tai Chi, yoga, and Pilates in the mix as well. These are, in essence, forms of relatively gentle exercise, at least for most people. (Yes, I realize that some yoga workouts can become quite intense.) What makes them more “mind-body” than other forms of low impact exercise? Finally, I’m really puzzled about the inclusion of massage therapy on this list. No doubt about it, massages feel good, and they are probably even useful for some musculoskeletal disorders, but what makes massage therapy a “mind-body” interaction? It’s a body-body interaction!

In fact, this very list looks to me like a blurring of the line between things that might be true mind-body interventions (meditation, progressive relaxation, guided imagery, etc.) and so-called “energy medicine” (reiki, healing touch or therapeutic touch, acupuncture, and qi gong). In fact, this is intentional, as there is a notice after the list that states, “As used in this plan, mind and body encompasses interventions from the three domains of mind/body medicine, manipulative and body-based practices, and energy medicine.” The problem here is that certain forms of what is called “mind-body” medicine might actually have value, whereas “energy healing” is pure religion or pseudoscience. Yet they are lumped together.

Truly, Strategic Objective 1 is The Bad and The Ugly.

It’s also evidence that neither Dr. Briggs nor the NCCAM leadership understand the problem that is at the heart of CAM. For example, look at this statement from Dr. Briggs in her introduction:

My experience as a physician who has cared for patients struggling with chronic, painful, and debilitating symptoms greatly informs my perspective on our work. When I began medical school, one of my teachers taught that “the secret of care of the patient is in caring for the patient.”* I took these words to heart. Symptoms matter, and few would dispute the fact that modern medicine does not always succeed in alleviating them. Few would also dispute the need for better approaches for encouraging healthy lifestyle choices. These are places in which I believe CAM-inclusive approaches offer promise, and I look forward to exploring the possibilities in the years ahead.

No one, of course, is arguing that symptoms don’t matter, although I note with some amusement that some CAMsters might not be too happy with Dr. Briggs’ emphasis on symptoms given how they like to claim that “Western medicine” treats only the symptoms and CAM treats the “root cause” of disease. Or maybe they don’t care as long as they can claim the seeming mantle of scientific respectability that the very existence of NCCAM offers. Be that as it may, upon reading this, I can’t help but ask: How can “CAM-inclusive” practices offer promise above and beyond science-based medicine in encouraging healthy lifestyle choices, particularly when so much of CAM bases its recommendations on a prescientific understanding of how the body works? You have to know what the body needs before you can encourage healthy choices, and to a large degree we already do know what most American bodies need: More exercise, more fruits and vegetables in their diets, and less fat and calories. To add to that knowledge, we don’t need CAM. We need science-based medicine. More importantly, I would wonder on what evidence, specifically, Dr. Briggs bases her assessment.

Inquiring minds want to know!

Comments

  1. #1 Lola
    February 14, 2011

    re Natural products research
    “Heck, it’s even the sort of thing that a lot of pharmaceutical companies do when they try to isolate drugs from natural products”

    Pharma seems to be moving away from supporting this kind of research, at least a major pharm co I know has pretty much ditched this avenue after having done a fair bit of this research in the past.

  2. #2 SC (Salty Current)
    February 14, 2011

    A successful and robust CAM research enterprise must draw from…biomedical/behavioral scientists expert in cutting-edge scientific methods

    Behavioral scientists! w00t! Cash for me! I would love to know who turns to this stuff and why. But alas, I fear my approach wouldn’t be bold or cutting-edge enough for NCCAM. So, I have an idea for a proposal that might be up to their epistemic standards, like “Satanic Possession Amongst Reiki Users: An Empirical Investigation”:

    Satanic possession is a controversial area of the Sociology of Medicine. Critics think it is implausible that the Lord of the Underworld can take ownership of human bodies/souls. Thus, critics argue that continuing the scientific study of Satanic possession in alternative medicine is not worthwhile. Others, however, point to observational and anecdotal evidence that Satan is actively involved in the choice and practice of Reiki and other Eastern and non-Christian modalities (Vatican 1973), and argue that this important causal factor should not be rejected just because science has not been able to explain it….

    Funding, please.

  3. #3 DLC
    February 14, 2011

    I agree. NCCAM and (the almost comically misnamed) OCCAM need to be shut down, and whatever credible scientists there folded into other (read: Real) research efforts.
    I’m sure we could salvage some lab techs, equipment and maybe the odd PI or two ? Oh, wait, I forgot — sCAM works without any of that stuff.

  4. #4 Paul Browne
    February 14, 2011

    “Whether I’m being cynical or realistic I leave to the reader to judge. ”

    As a regular reader I’ll vote for realistic.

    Your absolutely right that the good parts of NCCAM, the parts that deal with healthe lifestyles and natural products, should be integrated into other NIH institutes where they be a better fit. I particularly dislike the fact that a healthy lifestyle is included in CAM, when it is – and perhaps should be even more so – an important part of mainstream medicine.

    Unfotunately this is another case of politics getting in the way of good policy, I doubt that the situation is going to improve anytime soon. Medical professionals and scientists can’t rely on politicians and bureaucrats
    to halt the spread of quackademic medicine…we have to take responsibility for that task ourselves.

  5. #5 Todd W.
    February 14, 2011

    I’ve noticed that “mind-body medicine” has been popping up more and more. At a large hospital near me, a new institute for mind-body medicine has been established. Most of what I’ve seen seems to be focused on the effects and reduction of stress, rather than any real CAM modalities, but it does have me a bit worried, particularly considering that a partner hospital not only has reiki as a treatment option, but holds seminars for CME credit!

  6. #6 Caudoviral
    February 14, 2011

    re Natural products research
    “Heck, it’s even the sort of thing that a lot of pharmaceutical companies do when they try to isolate drugs from natural products”

    Pharma seems to be moving away from supporting this kind of research, at least a major pharm co I know has pretty much ditched this avenue after having done a fair bit of this research in the past.

    No, it really really isn’t. Having worked under various people doing antibiotic, antiviral, and pesticide discovery, rule 1 is: “There is nothing we can make in a lab that evolution can’t have done better.” The trick is finding and optomising extant natural products. Who would want to waste money generating compounds de novo if there is an alternative?

    And the current revolution in proteomics is only going to make this easier, more accurate, and safer.

  7. #7 prn
    February 14, 2011

    Who would want to waste money generating compounds de novo if there is an alternative?
    The patent agent, many CEOs, and apparently many synthetic biochemists.

    A few years ago I wandered into a university biolab after hours, looking for a fugitive HHMI fellow and got to talking to some unknown prof about natural vs synthetic. I was a little taken aback at the strength of his hostility to potential therapeutics based on natural molecules, even as a hypothetical example, where his basic schtick was “reverse engineering” natural moieties.

    I felt fortunate to be able to mention a few economically non-threatening substances with recent research and demonstrated medical benefits, away from a perceived hot zone, before I excused myself.

  8. #8 Candy
    February 14, 2011

    As an Iowa resident, I feel very sad about Senator Harkin’s endorsement of woo. In every other way, he’s an excellent senator: He’s pro-choice, author of the Americans with Disabilities Act, enthusiastic supporter of health care reform . . . it’s unfortunate that he’s gone down the alt-med path.

    I’ll continue to work for him when he’s up for reelection, but I’m definitely going to squawk about this issue.

  9. #9 Denice Walter
    February 14, 2011

    Why oh why, in this era of post recessionary frugality, is there not a person ( an Elizabeth Warren of SBM?) or a committee to separate the wheat from the chaff – the science-based from the whimsy-based- and to manage the elimination of redundant studies? Why fund research when we *already* realize its impossibility? ( See “toothpicks/ accupuncture” @RI)

    In the behavioral area, I haven’t even been peeking lately, lest I ((shudder)) find scientological inventions on addiction, orthomolecular psychiatry for SMI, enhanced communication, past life regression, karmic explanations for depression, astrology and partner selection, EFT, hallucinogenically-facillitated shamanism, etc. ( Yes. I am being facetious. But not entirely).

  10. #10 Dianne
    February 14, 2011

    I’m still wondering what constitutes CAM? For example, if you claim you’re studying the effects of a natural treatment derived from yew bark and periwinkles, would they fund your taxol/navelbine study? (If there’s anything left to study with that combination.)

  11. #11 lilady
    February 14, 2011

    Having worked in a number of bureaucracies; trade publications, insurance companies and in public health, I understand how difficult it is to close down a unit. At issue here is that these NIH divisions should never have been set up and funded. We have Senator Harkin’s intervention to blame for that. It is so difficult to understand that even small allocations out of the overall NIH budget go to NCCAM and to OCCAM, when other NIH divisions that do real research, need the money and resources.

    Tom Harkin joins other Senators who have use public tax dollars for particular “agendas”, including Senators Dan Burton and the newly elected Richard Blumenthal (D. Conn.)

    Dan Burton set up hearings about thimerisol-vaccine-autism links. He stated at the time it was because of his grandson, “I saw him afflicted with autism within a few days of receiving nine immunizations.” The hearings were a free-for-all with all sorts of woo meisters testifying and Dan Burton, funded with public tax dollars ($ 25 million), a research study to evaluate chelation as therapy for autism.

    Senator Burton, on his web site has a special section devoted to autism with portals for “information about autism” including the “usual suspects”. Nice to know that the anti-vaccine groups are getting publicity at a tax-payer funded web page.

    Now Richard Blumenthal, had some difficult time getting elected in 2010 due to recorded interviews that inferred he served his country in Viet Nam…it was “all a big mistake.” He apologized that his words in support of the armed services led people to believe he actually served in Viet Nam. Other issues were raised as well about his tenure as state attorney-general, prior to the senate campaign. However, I heard no mention of the Blumenthal-instituted anti-trust suit against the Infectious Disease Society of America (IDSA) which questioned their recommendations for the diagnoses, blood tests and treatment guidelines. Anti-Trust suit?…against the IDSA?…oh yeah! The basis of the suit, according to the attorney-general was that the strict guidelines, didn’t allow for “alternative” medicine treatments, as health care insurance companies wouldn’t pay for “chronic” Lyme disease diagnoses via bogus Lyme urine antigen tests, treatment with modalities such as months/years long IV antibiotics, supplements and other woo treatments. The IDSA Guidelines were “reviewed” by an independent group of specialists and after five long years, the IDSA Guidelines were determined to be correct. Jeez, talk about misuse of your office for advance of your personal agenga and to get some additional votes.

    As a taxpayer and as a health care professional, I prefer to have elected officials caught in the acts of graft, accepting of gifts from lobbyists and sexual misconduct…its much more fun.

  12. #12 sheldon101
    February 14, 2011

    A heads up
    —————

    If you live in Washington, MAIL a letter (much more effective than email)to your state senator urging passage of SB5005, which requires a signature from a MD or a ND (sad)or PA or Advanced Registered Nurse Practioner on a form requesting a philosophical or religious that they have explained the benefits and risks of immunization.

    The obvious reasons are set out here. http://apps.leg.wa.gov/documents/billdocs/2011-12/Pdf/Bill%20Reports/House/1015%20HBA%20HCW%2011.pdf

    What’s delightful is how Barbara Loe Fisher at NVIC explains that this provision violates informed consent.

  13. #13 Prometheus
    February 14, 2011

    I’ve been working on an alternative approach – subverting the NCCAM for legitimate research.

    Over the past year, my lab and a number of other labs have been submitting proposals to the NCCAM which – although couched in woo-speak – are actually legitimate microbial and viral research projects.

    Although my proposals haven’t yet “made the cut”, I’ve gotten several very favorable reviews, most of which ask me to show specific ways in which my research would apply to CAM modalities currently in use. One other lab in our “conspiracy” has actually gotten funding! For legitimate bacteriological research!

    I won’t reveal the names of the researchers (or their projects), but I feel we have taken the first step toward transforming (in the biological sense) the NCCAM from within.

    It really wasn’t that hard – the NCCAM gets its research proposals primarily from people who don’t know science from Scientology, so a proposal from a legitimate scientist who has gotten research proposals funded must look like a diamond among the clods. So far, the only problem we have run into is getting our proposals to be sufficiently non-scientific to meet the NCCAM criteria.

    Clearly, we need to learn more about the “science” of magic (i.e. CAM therapies) in order to make our proposals look like the sort of crap they’d be interested in funding. This new “strategic plan” of the NCCAM looks like the perfect blueprint for my next assault.

    Tallyho!

    Prometheus

  14. #14 Jay Gordon, MD, FAAP
    February 14, 2011

    Thanks, David, for writing about this important topic. I agree that the FDA’s approval processes are inadequate and that we need to better protect medical consumers.

    http://news.yahoo.com/s/ap/20110214/ap_on_he_me/us_med_medical_device_recalls

    Best,

    Jay

  15. #15 Prometheus
    February 14, 2011

    Jeez, can’t “Dr. Jay” stay on topic for at least the first sentence?

    He needs to change his signature line to:

    “Jay Gordon, MD, FAAP, SPAMBOT”

    Prometheus

  16. #16 CanadianChick
    February 14, 2011

    Dr Gordon, were you reading the same post as the rest of us?

  17. #17 Science Mom
    February 14, 2011

    Oh come on now guys; don’t be so hard on Dr. Jay. After all, it ain’t easy being an avant-garde medical performance artist.

  18. #18 Jay Gordon, MD, FAAP
    February 14, 2011

    “Oh come on now guys; don’t be so hard on Dr. Jay. After all, it ain’t easy being an avant-garde medical performance artist.”

    Science Mom, that is a wonderful turn of a phrase. Thank you.

    I thought the topic was medical scam attempts. I’ll take Food and Drug Administration medical device approval process for $400, Alex.

    Best,

    Jay

  19. #19 Chris
    February 14, 2011

    Jay:

    I thought the topic was medical scam attempts.

    No, it isn’t. Perhaps you should try reading the article before commenting.

  20. #20 drmyk
    February 14, 2011

    Seriously. What are the paylines for these clowns? I’m re-writing my 8th percentile niaid and sending it to them.

  21. #21 V. infernalis
    February 14, 2011

    Maybe everyone should just mail NCCAM a copy of Trick or Treatment and/or Bad Science. It would save them a fortune.

  22. #22 film izle
    February 15, 2011

    I mean, really?? I’m a scientist, and just reading that even made *my* eyes glaze over. If one thing they’re trying to convey is the importance and relevance of the scientist’s research to GQ readers, what percentage of the readers are really going to walk away with a deeper understanding of what Dr. Jamieson does by reading that description? It would have been a small thing to ask each participant to submit a layman-friendly version of their research (their “elevator talk” description, for example) for GQ to include.

    Finally–one of the “scientists” is Dr. Oz. What is he doing in there? One, I would think he’s already well-known enough; why not save that spot for another scientist? Two, yes, I know he’s actually done research and published, and is on the faculty at Columbia. Fantastic. He’s also a serious woo peddler, who has even featured everyone’s favorite “alternative” doc, Joseph Mercola, on his talk show, and discussed how vaccines may be playing a role in autism and allergies (despite mounds of evidence to the contrary). This seems to completely contradict their goal of “research funding as a national priority,” since Oz is often (and Mercola is always) highly critical of “mainstream medicine.” I really don’t understand his inclusion, and think it’s to the detriment of the rest of the campaign.

  23. #23 prn
    February 15, 2011

    …CAM belief that somehow the natural plant is superior to purified components
    I recall Victor Herbert (not the musician) shrilling at beta carotene starting to become “Readers Digest” mainstream medicine precisely for this “CAM belief”. Herbert felt that dietary mixed carotenoids’ performance could not be achieved from a pure (synthetic) carotenoid and that there were too many optically active carotenes to try to synthesize and blend economically.

    Of course, maybe he was some closet naturo nutritionist, or crazy.

  24. #24 Medicus Balatro
    February 15, 2011

    “Now Richard Blumenthal, had some difficult time getting elected in 2010 due to recorded interviews that inferred he served his country in Viet Nam…it was “all a big mistake.”

    As a “health care professional” whatever that means, I would have thought you would know the difference between implied and inferred. Or perhaps you aren’t anything of the sort, and are just posting what you have been told to post, perhaps for course credit?

    “He apologized that his words in support of the armed services led people to believe he actually served in Viet Nam. Other issues were raised as well about his tenure as state attorney-general, prior to the senate campaign.”

    Lol. I think…lol. Lol, I can’t stop laughing, sorry. What is this place called Viet Nam? Is it anywhere near Vietnam? Just a guess…

    “However, I heard no mention of the Blumenthal-instituted anti-trust suit against the Infectious Disease Society of America (IDSA) which questioned their recommendations for the diagnoses, blood tests and treatment guidelines.”

    Yes Blumenthal woke up one day and just randomly decided to sue the IDSA :/ Sorry, it was patients with lyme disease that pressed the AG to sue the IDSA over conflicts of interest in drawing up the guidelines for lyme disease that are known the world over to be highly fraudulent and have made a laughing stock of the IDSA in many countries.

    “Anti-Trust suit?…against the IDSA?…oh yeah!”

    Oh you’re a good little sheep aren’t you? I guess the IDSA is above any wrong doing, and no one should ever question whatever they do, no matter how fraudulent. Baaaaa…baaaa.

    “The basis of the suit, according to the attorney-general was that the strict guidelines, didn’t allow for “alternative” medicine treatments, as health care insurance companies wouldn’t pay for “chronic” Lyme disease diagnoses via bogus Lyme urine antigen tests, treatment with modalities such as months/years long IV antibiotics, supplements and other woo treatments.”

    Wrong, wrong and wrong again. It was based on COI. I’m guessing you’re aware of your own disinformation. Either that or you are an idiot, I don’t know which is worse.

    “The IDSA Guidelines were “reviewed” by an independent group of specialists and after five long years, the IDSA Guidelines were determined to be correct. Jeez, talk about misuse of your office for advance of your personal agenga and to get some additional votes.”

    Lol… wrong again…lol…wrong lol…hee hee. 5 long years? How much longer were these years than normal years? See in science we like to use actual numbers. Oh the stupid, it burns.

  25. #25 jen
    February 15, 2011

    p.s., I find it instructive, Orac, that you never took on J. B. Handley’s Dissection of the Autism Science Foundation’s use of the Hungry Lie. (and the stupid studies involved therein).

  26. #26 lilady
    February 15, 2011

    @ Medicus Balatro: I am a trained public health nurse. I don’t need any “course credit”. I am trained in all facets of epidemiology; look that word up to find out what qualifies a person to work in that field….and your credentials are? I have no agenda, what about yours?

    Playing your game of word usage, I invite you to key in “Vietnam-What’s in a name” and you’ll find that Viet Nam is the correct usage for the area where U.S. armed forces
    were fighting in Viet Nam.

    Are you inferring that Blumenthal prevailed? I don’t think so. The IDSA Guidelines for diagnosis, testing for the presence of Lyme Disease and antibiotic treatment for Lyme disease…and every other infectious disease, are the gold standards used by physicians.

    Listen Lymie, when you get some credentials and experience working in the field of epidemiology, I “might” appreciate some of your comments about zoonotic diseases. Or perhaps your posting name means you are one those physicians who lost their license due to serious patient injury as a result of alternative medicine treatment of Lyme disease

  27. #27 T. Bruce McNeely
    February 15, 2011

    Just to enlighten the Medical Fool some more:

    Blumenthal did not “imply” that he served in Viet Nam, he flat out said it. Lilady also didn’t say that Blumenthal inferred that he served in Viet Nam, she said that the interview inferred it. Strictly speaking, that is more correct. However, most modern dictionaries state that the two words can be used interchangeably. I don’t agree, but then, I’m not the King of English.

    Also, Viet Nam is perfectly correct. That’s the spelling the United Nations uses.

    Tip: When you play the Grammar Nazi, it really helps to be correct.

    the guidelines for lyme disease that are known the world over to be highly fraudulent and have made a laughing stock of the IDSA in many countries.

    Really? Which countries?

  28. #28 herr doktor bimler
    February 15, 2011

    #24 Posted by: Medicus Balatro | February 15, 2011 3:48 AM
    #25 p.s., I find it instructive, Orac
    Posted by: jen | February 15, 2011 11:14 AM

    Nymfail!

  29. #29 lilady
    February 15, 2011

    @ T. Bruce McNeely: Thanks for the post in support and I love your “Grammar Nazi” depiction of the medical fool. I fess up to having an affliction with run-on sentences…but I’m working on that.

    I believe the medical fool referred to COI (conflict of interest?) as the basis of Blumenthal’s lawsuit. Our colleagues at Quack Watch have done an update on Lyme Disease: “Lyme Disease Questionable Diagnosis” which details some of the conflicts of interest revealed at hearings to remove licenses of “LLMD” (Lyme Literate Medical Doctors).

  30. #30 Medicus Balatro
    February 15, 2011

    “Playing your game of word usage, I invite you to key in “Vietnam-What’s in a name” and you’ll find that Viet Nam is the correct usage for the area where U.S. armed forces
    were fighting in Viet Nam.”

    You’d be correct if it was 1940. Unfortunately it isn’t so you are wrong. Have enough integrity to admit it.

    “Are you inferring that Blumenthal prevailed? I don’t think so. The IDSA Guidelines for diagnosis, testing for the presence of Lyme Disease and antibiotic treatment for Lyme disease…and every other infectious disease, are the gold standards used by physicians.”

    Ok, just so we’re clear.

    Imply: Strongly suggest the truth or existence of (something not expressly stated).

    Infer: To derive as a conclusion from facts or premises.

    I realize its a subtle difference but I’m sure an educated epidemiologist such as yourself can see it. If you can’t see that type of distinction, having a discussion on the IDSA conflicts of interest would be hopeless.

    “When you get some credentials and experience working in the field of epidemiology.”

    Lol. I get the feeling that you think that people take epidemiology seriously. I can assure, only epidemiologists do. Epidemiology is almost as much woo as psychiatry. Ever heard of HRT? Science my @ss.

    “Or perhaps your posting name means you are one those physicians who lost their license due to serious patient injury as a result of alternative medicine treatment of Lyme disease”

    Leaving the phrase “alternative medicine treatment” aside for the moment…alternative as in prescribing antibiotics for a bacterial infection? Yes that’s so woo. What a quack idea, actually giving antibiotics to patients suffering from a bacterial infection until it clears. What will these quacks think of next, giving antifungal medication to patients suffering from a fungal infection? Perhaps all the epidemiologists can have a meeting and put an end to that kind of quackery once and for all.

  31. #31 Jennette Green
    February 16, 2011

    There are a lot of influences; these influences will not necessarily mean that the science or funding will be biased. Transparency, as in making the clinical data and study methods available for independent review and critique, will be essential

  32. #32 lilady
    February 16, 2011

    @ Medicus Balatro a/k/a Medical Fool: You really are a troll..playing the troll game, with semantics.

    I’m still waiting for your credentials and your “take” on the Quack Watch article that I referenced regarding conflict of interest found during the hearings prior to LLMDs being defrocked of their license. It was found during each of those hearings that LLMDs prescribed IV antibiotics for months on and prescribed “pulse” IV therapy for years on end due to their financial interests and/or kickbacks from IV home therapy companies. Many of their patients were treated for septicemia and some of them died as a result of treatment for “chronic” Lyme disease.

    Some of the LLMDs used colloidal silver on their patients, still others underwent other unproven treatment all for a disease “that never was”. Many of these patients’ diagnoses were based solely on the lyme urine antigen test, which has been found to be a totally bogus testing modality for determining the presence of the b. Burdorferi bacteria.

    Very few of the “Lymie” patients ever had Lyme disease and they were found to have recovered…following a short course of oral antibiotics. Blood testing of these patients were done with the Elisa screen and confirmatory Western Blot tests, as recommended by real scientists and real infectious disease practitioners.

    Tell me about your credentials and your experience in medical epidemiology..or in infectious diseases, neurology, rheumatology, cardiology, lab sciences, biology or….be gone troll.

  33. #33 herr doktor bimler
    February 16, 2011

    Tell me about your credentials and your experience in medical epidemiology
    Medicus Balatro knows the difference between ‘imply’ and ‘infer’, which appears to be the most important qualification.

  34. #34 Medicus Balatro
    February 17, 2011

    “I’m still waiting for your credentials and your “take” on the Quack Watch article that I referenced regarding conflict of interest found during the hearings prior to LLMDs being defrocked of their license.”

    As much as I would like to respond to your query, apparently the Orac has turned on the truth filter, and removed my previous posts. Censorship is, of course, the most effective way to prevail in a discussion.

  35. #35 Chris
    February 18, 2011

    Medicus Balatro:

    As much as I would like to respond to your query, apparently the Orac has turned on the truth filter, and removed my previous posts. Censorship is, of course, the most effective way to prevail in a discussion.

    Why are you lying about something that can be easily checked? I see that they are still here:

    http://scienceblogs.com/insolence/2011/02/lets_do_some_real_science_for_a_change_t.php#comment-3301355
    and
    http://scienceblogs.com/insolence/2011/02/lets_do_some_real_science_for_a_change_t.php#comment-3307940

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