Well, I’m back.
Grant frenzy is over (for now), and I have a couple of weeks before the next cycle begins again. Well, actually, it’s more than that. The next big NIH grant deadlines are in October and November, but the Susan G. Komen Foundation grant notices just showed up in my e-mail the other day, and the deadlines for its preapplications are in early to mid-August. The fun never ends, and if the Army approves my preapplication for its Idea Award grant application I’ll have a full application to write in August too. It’s times like these when I ask myself why it is exactly that I do this again.
Oh, yes. It’s because I love science so much.
Actually, it’s true. I do love science, which is one reason why I get so agitated when I see it abused. Since I also love medicine, it agitates me even more to see both science and medicine abused, which is what I see happening with the infiltration of quackademic medicine into what were once bastions of evidence- and science-based medicine. It’s also part of the reason why I got so annoyed by the outright apologia for quackademic medicine that I saw in David Freedman’s recent Atlantic article The Triumph of New-Age Medicine. As you might recall, a couple of weeks ago I made my displeasure known and then did it again after Mr. Freedman went on the counterattack against his critics.
While I’ve been…preoccupied trying to keep my lab in existence another few years, I noticed that there’s a “debate” at The Atlantic about Freedman’s article entitled Fix or Fraud? You can tell from the very beginning exactly which side of the issue The Atlantic comes down on by its choice of debaters. (Hint: It’s not “fraud.”) The lineup is stacked with a veritable pantheon of “heavy hitters” in the alt-med movement, all arrayed initially against Steve Salzberg, who appears to have agreed to take on the role of the token skeptic as he correctly entitled his rebuttal A “triumph” of hype over reality. Later, David Colquhoun was added to the mix and contributed a post entitled America, Land of the Health Hucksters, but I strongly suspect that this was a result of complaints about how blatantly, obviously, and unabashedly stacked against skeptics the first lineup was. Besides the author of The Atlantic‘s paean to alt-med, arrayed against Salzberg and Colqhoun are:
- Josephine Briggs, MD, PhD, Director, National Center of Complementary and Alternative Medicine (NCCAM), and Jack Killen, MD, Deputy Director, NCCAM: Don’t Dismiss These Treatments as Placebos
- Andrew Weil, MD, Founder, Arizona Center for Integrative Medicine: Changing Times Call for Smarter Doctors
- Dean Ornish, M.D., founder and president of the non-profit Preventive Medicine Research Institute in Sausalito, California, Why Health Care Works Better Than Disease Care.
- Mimi Guarneri, M.D., clinical cardiologist and the founder of the Scripps Center for Integrative Medicine in La Jolla, California (and the woo-meister who was paired with Steve Novella on The Dr. Oz Show), First, Do No Harm.
- Vasant Lad, M.A.SC., founder, director, and principal instructor at the Ayurvedic Institute in Albuquerque, New Mexico, Why Traditional Medicine Matters.
- Reid Blackwelder, M.D., board member of the American Academy of Family Physicians and a professor of family medicine at Eastern Tennessee State University, The Family Physician of the Future.
Then David Freedman himself chimes in with a post entitled: What’s Eating the Small, Loud Band of Alt-Med Critics?
Since there’s so much here, I can’t deal with it all, even writing an Orac-length post. Even though I wanted to comment one more time, I don’t want to comment multiple times. Consequently, for the posts by Drs. Briggs and Weil, I’ll refer you to what is an excellent deconstruction of the nonsense contained therein (in the second part of the post). I’ll then deal briefly with each of the last few posts, because they’re all very telling in their own ways.
But first, let’s deal with the perpetrator of this mass of apologia for pseudoscience, Mr. Freedman. His little rant, apparently provoked by David Colquhoun’s excellent bit of no-holds-barred, take-no-prisoners blogging, is an obvious bit of “framing” and not in a good way. All I can say is that Mr. has really thin skin. Paper thin. Cell membrane thin. Really, really thin:
I give credit to the enthusiasm and passion of the small band of deeply anti-alternative-medicine warriors who have voiced their displeasure with my article. And let’s be clear, this is a very small band. As I think was made plain in my article, most mainstream physicians and physician researchers pretty much agree with my basic argument.
Once again, one wonders how Mr. Freedman knows that “most mainstream physicians and physician researchers pretty much agree” with his basic argument. Unless he’s done a large, well-designed poll, he can’t possibly say that. Even if he interviewed 100 physicians and researchers, that is a very small fraction of all the physicians out there, and it’s not even a scientific sampling. It’s a biased sample. After all, Mr. Freedman was doing a story about alternative medicine, and where do you find “experts” on alternative medicine? At centers of quackademic medicine. And who are the faculty at centers of quackademic medicine? Believers in alt-med, of course, believers like Dr. Brian Berman, the acupuncture aficionado profiled.
He also makes much of how he is supposedly in “total agreement” with major points made by Colquhoun, Salzberg, Novella, and myself:
I’d hate myself, if it weren’t for the fact that I don’t do any of this in the article. Rather, I point out high up in the piece, and with no bones about it, that science has pretty clearly shown that the core treatments of alternative medicine don’t provide the direct physical effects that they are claimed to provide by practitioners. They work via the placebo effect. Now could someone please explain to me how it is that I could be defending pseudoscience in an article in which I so clearly say it’s pseudoscience, and that it doesn’t provide the claimed benefits? I do suggest there’s a placebo benefit — but so do my critics. We’re in perfect agreement.
At best Freedman is being clueless here, at worst disingenuous. While it is true that Mr. Freedman sort of agreed with the skeptics, it’s how he did it that makes the difference. First, he sets up his entire premise as a false equivalence between science-based medicine and alt-med quackery. Alt-med quackery is placebo, but science-based medicine often doesn’t work and there is placebo effect. Of course, in studying science-based treatments, we try very hard to control for nonspecific effects and placebo effects because we want to know how much real physiological effects due to the intervention provide a benefit. In alt-med, placebo effects are the whole point, and the rationale for the treatments are wrapped in mystical, magical mumbo-jumbo. Basically, the whole premise of Freedman’s article boiled down to arguing that, if real doctors can’t provide the time and empathy patients crave, then maybe we should let the quacks to it.
He is, however, very good at painting his critics as a small band of dogmatic, unreasoning, ideologically motivated believers in his misnamed “scienceology” (or, as creationists would call it, scientism). Sound familiar? It’s the same sort of framing frequently used to marginalize atheists and agnostics. Since there is heavy overlap between skeptics and atheists and agnostics, this is not surprising. One wonders if David Freedman is taking lessons from Deepak Chopra or Michael Egnor.
But on to the other respondents. I won’t say that much about Dean Ornish’s post, mainly because I’ve blogged extensively about Dr. Ornish before. His post is a masterful example of the alt-med/CAM/integrative medicine phenomenon known as the “bait and switch.” Consistent with that, Ornish harps on his diet and lifestyle changes, even though diet and lifestyle changes are not in any way “alternative.” He also brags about his research that found changes in gene expression in the prostate in response to his diet, a study that I didn’t find particularly impressive. At the very least, it was far overblown and Ornish drew exaggerated conclusions from it that are not supported by his data, as he touted his paper on telomerase, another paper I didn’t find nearly as impressive as CAM advocates do.
I was, as you might imagine, underwhelmed.
Next up is Dr. Guarneri. Her entire article can be boiled down to this:
So why are we arguing over whether or not acupuncture is a placebo? We have three licensed acupuncturists and two physician acupuncturists at The Scripps Center for Integrative Medicine. I can cite patient after patient who has received benefit from our acupuncture program. And in regard to Dr. Salzberg’s post, I have never seen a punctured lung or infection as a result of an acupuncture treatment. While I am sure complications can occur, they are certainly much less common than the hospital-acquired infections I saw as an interventional cardiologist.
“I can cite patient after patient.” Yup, that’s anecdotal evidence being touted over science and clinical trials. Note how Dr. Guarneri doesn’t cite a single well-designed, randomized, double-blind clinical trial of acupuncture. She’s seen it work (or thinks she’s seen it work), and to her that is enough, just like our favorite apologist for the anti-vaccine movement, Dr. Jay Gordon, has seen children become autistic after vaccination (or thought he’s seen children become autistic after vaccination), and that’s enough for him. No need for clinical trials, epidemiology, or anything else for that matter. It’s the triumph of “personal clinical experience,” which can be highly misleading, over science. Remember, to paraphrase Richard Feyneman, you must not be fooled, and you are the easiest one to fool. Science is nothing more than a system designed to minimize the chances of being fooled or making a biased interpretation of observations.
The rest of Dr. Guarneri’s post is similar to Ornish’s in that she cites some of Ornish’s work. She then parrots Freedman by complaining about shortcomings of “conventional” medicine and concludes by cherry picking studies supporting the benefits of diet and lifestyle, thus completing the circle and coming back to the classic alt-med “bait and switch.”
In the next post, Vasant Lad sings the praises of Ayurvedic medicine, which is a lot like traditional Chinese medicine in that it is derived from a prescientific, vitalistic, religious misunderstanding of how the body works and what causes disease. Not that that stops Lad from making this evidence-free assertion:
Ayurveda is a safe alternative approach, a medical system that focuses on preventing disease and treating its root causes. Ayurveda provides specific advice on proper diet and lifestyle, as well as cleansing and detoxification programs. And unlike modern allopathic drugs, Ayurvedic treatments are tailored to the specific constitution (prakruti) and imbalances (vikruti) of each individual person. Following these guidelines can help prevent future heart attacks, stroke paralysis, or even cancer. It is also useful for chronic conditions such as rheumatoid arthritis and sciatica, improving quality of life in a way that modern medicine has not managed to do.
One notes the similarities between these “imbalances” to the “Western” prescientific concept of “balancing the four humors.” Instead of science as a basis for medicine, Lad appeals to ancient knowledge:
As the Atlantic article points out, modern medicine relies on clinical trials to test the effectiveness of a drug. The Ayurvedic approach is a bit different. In addition to a history of developing and testing new substances, Ayurveda relies on its own pharmacological “database,” recorded in ancient texts such as the Charaka Samhita. Every herb we use has logic behind it, based upon the qualities of the herb and its effects as it passes through the digestive tract. This action is not placebo; it is based upon a centuries-old understanding of how an individual’s constitution interacts with a specific substance.
In other words, there’s no science here. Only appeals to ancient prescientific beliefs and a plaintive claim that Ayurvedic medicine is not placebo.
The final panelist, Reid Blackwelder, doesn’t so much appeal to ancient knowledge as much as joining in the chorus of CAMsters who try to paint “conventional” medicine as dangerous (citing without context the estimates of death and destruction that allegedly occur as a consequence of the use of prescription drugs. He then adds the typical appeal to placebo effects, striving against science, as Freedman and others have done, to make the weakness of alternative medicine (that the vast majority of its modalities have no specific effects, that they are in reality placeboes) into its strength, topping it off with the classic bait and switch.
In the end, The Atlantic has done its readers a grave disservice. First, it published the poorly argued, biased apologia for pseudoscience that was Freedman’s original article. Then it compounded its original error by holding a pseudodebate in which the deck was hopelessly stacked against defenders of science-based medicine, lining up practically every heavy hitter in the world of woo other than Deepak Chopra and Dr. Oz against Steve Salzberg and David Colqhoun, while allowing David Freedman to paint his critics as an angry, irrational, hate-filled tiny minority, the better to dismiss them as irrelevant. The classic CAM “bait and switch” is not a valid argument, nor are diet and lifestyle interventions “alternative.” Worse, the poor, misunderstood placebo effect has become an all-purpose excuse to justify the infiltration of quackery into institutions of science-based medicine.