Respectful Insolence

One of the consistent themes I’ve maintained on this blog over the years is to combat in my own small way in my own small corner of the Internet, the influx into medical academia of medicine based not on science, but on prescientific notions of disease, vitalism, and magic, such as homeopathy (which is sympathetic magic), reiki (which is faith healing), and the like. In general, we expect professional societies to maintain and support the scientific basis of medicine. Unfortunately, increasingly, medical societies have been failing us.

Here’s just a short reminder of yet another example. This time, it’s the American Academy of Family Physicians, specifically the its invitation of Dr. Andrew Weil to be its keynote speaker at its 2012 AAFP Scientific Assembly:

The 2012 Assembly will commence with a captivating, inspirational keynote address from Dr. Andrew Weil speaking on “Why Our Health Matters.” Dr. Weil is one of the world’s foremost authorities on health and wellness. He founded the field of integrative medicine which endeavors to create an intersection of alternative and conventional medicines.

Dr. Weil is in demand. He was ranked the #1 choice for keynote speaker by recent Assembly attendees.

Lovely. The keynote speaker of the AAFP this year is someone who has started up his own fellowships of woo (and is trying to offer board certification for them) and who has demonstrated that he doesn’t like evidence-based medicine. In many ways, he is the most important figure in the movement to “integrate” quackery with scientific medicine. What’s even more depressing is that he was the number one choice of AAFP members who attended recent Assemblies.

So, the “integration” of pseudoscience and quackery with medicine continues apace, this time aided and abetted by the AAFP. When will we ever learn? As Mark Crislip so aptly put it, “If you integrate fantasy with reality, you do not instantiate reality. If you mix cow pie with apple pie, it does not make the cow pie taste better; it makes the apple pie worse.”

Or, as I put it:

If you integrate quackery with real medicine, you do not produce better medicine. Instead, you turn quackery into medicine and medicine into quackery, which is exactly what’s happening in medicine right now. Much of integrative medicine represents a return to the past, and not in a good way. Rather, it’s a return to the past where the four humors qi determined health and disease, miasmas unspecified and unknowable “toxins” were responsible for many diseases, and praying to God (or the gods) for healing energy healing and reiki was the order of the day. That’s what we’re “integrating” into scientific medicine.

Time to go back to my vacation/staycation. At least I have a baseball game to go to tonight, where I can chill, have a beer, and root for the proverbial home team. I must admit that I have found a rather interesting study about chemotherapy that I might read and dissect for relaxation, given that I note that the alt-med types are already harping on it as “proof” that “chemotherapy doesn’t work.” Or not. At least, not today, which is a day to relax.

Comments

  1. #1 MikeMa
    August 7, 2012

    It seems that money or its cousin fame can distort or destroy the best people & ideas. Dr Oz was once a respected cardiologist. Now he champions woo. The ‘listen to your patients’ idea, which might have been used to help busy docs slow down and pay more attention was co-opted to include ‘listen to the latest woo I found on the internets’.

    Weil is a bad choice for anything other than comic relief.

  2. #2 palindrom
    August 7, 2012

    Does anyone know if there’s any organized pushback from the membership?

  3. #3 Brian Morgan
    August 7, 2012

    As the Texas Academy of Family Physicians is a Chapter of the American Academy of Family Physicians (according the latter’s website) does this invitation of Dr Andrew Weill as a speaker at the latter’s event exactly counterbalance the presence of Alison Singer as speaker at the Texas Immunisation Summit in 2010? Maybe it more than counterbalances it as this is a US national event not a state one and Weill is a doctor, and Singer is not?

    So can Judge Meachum breath a huge sigh of relief now?

  4. #4 Denice Walter
    August 7, 2012

    ( note @ Mike Ma:

    Oz has recently and publicly shown support for vaccines which has not exactly endeared him to woo-meisters – noted by both Adams and Null: does this spell trouble in paradise?)

    In general, woo-meisters will trumpet Weill’s presence at the assembly as proof positive that medicine is indeed experiencing the long-awaited paradigm shift and that the tide is turning.

    The awful truth – as Orac has illustrated- is that woo is indeed infiltrating medicine and its advocates are perhaps justified in jumping for joy.

    However, I have noticed that nearly everything that occurs is taken as a sign that the tide is turning and their ideas about what the paradigm shift would emcompass are probably merely pipe dreams ( e.g a shift away from pharmaceuticals and professional education/ training to supplements, herbs, faith healing, spirituality, energy medicine and gifted amateurs).

  5. #5 THS
    cool cloudy morning
    August 7, 2012

    The chemotherapy study link at the end of this blog post is to an internet news article regarding a Nature Medicine item. Apparently it describes an interesting & worrisome complication of chemotherapy.
    The comments following the Yahoo article are depressing (e.g.: look up Gerson, etc.)

  6. #6 palindrom
    August 7, 2012

    ” … medicine is indeed experiencing the long-awaited paradigm shift and that the tide is turning. ”

    I suppose it’s possible that the moon is in the seventh house, and Jupiter is aligned with Mars, but I honestly haven’t checked.

  7. #7 Denice Walter
    August 7, 2012

    @ palindrom:

    Perhaps. Or it may coincide with the Mayan Calendar running out in December, ushering in a new Golden Age.

  8. #8 Jay Chaplin
    University of Washington
    August 7, 2012

    @ Denice Walter, 11:29 am

    Since the Mayans did not correct for leap years (of which we have had over 500 since the inception of the current calendar system) we are more than 17 months ahead of the Mayan calendars. The mid-length Mayan calendar ran out in July of last year. The long-form Baktun calendar still has over 17,000 years to go.

  9. #9 Denice Walter
    August 7, 2012

    @ Jay Chaplin:

    Thank you for that information: I am personally hoping that it is NOT a new Golden Age because then I would have to go out and replace my entire wardrobe- and Lord knows what that would cost- I believe that floaty, flimsy Greek-ish chemises would be *de rigeur*- and I don’t have any at the moment. Probably lots of white and pastels- black would be straight out.

  10. #10 kurt youngmann
    August 7, 2012

    “Weill is one of the worlds leading authorities on health and wellness.”

    What? I’m amazed that no one has expressed indignation over this claim by by the AAFP. Certainly no one can believe such a comment.

  11. #11 tgobbi
    August 7, 2012

    “Dr. Weil is one of the world’s foremost authorities on health and wellness.”

    Say what? Weill an authority on anything besides B.S? I’m amazed that no on has expressed indignation that the AAFP has the nerve to make such a claim!

  12. #12 Narad
    August 7, 2012

    I suppose it’s possible that the moon is in the seventh house, and Jupiter is aligned with Mars, but I honestly haven’t checked.

    I thought the other night that love was steering the stars, but in retrospect, it seems to have just been scrumpy.

  13. #13 In Vitro Infidelium
    August 7, 2012

    ERV has waded into Oracian territory http://scienceblogs.com/erv/2012/08/06/an-alternative-course-of-treatment-for-a-kid-with-cfs-you-know-where-this-is-going/ exposing a US Family Practitioner of just the sort who would appreciate Andrew Weil

  14. #14 Eric Lund
    August 7, 2012

    palindrom @1111: I see no evidence that peace is guiding our planet, so I don’t think so. But you know how hard it is to pin down that kind of prediction.

  15. #15 Narad
    August 7, 2012

    Since the Mayans did not correct for leap years (of which we have had over 500 since the inception of the current calendar system) we are more than 17 months ahead of the Mayan calendars.

    It’s a day-counting system, so leap years are irrelevant. All that matters is the assumed start date of the baktun.

  16. #16 Rogue Medic
    United States
    August 7, 2012

    The chemotherapy story (I was reading about it elsewhere) is about a complication with chemotherapy.

    It does not state that any of the patients who have been in remission for an extended period due to chemotherapy have not been helped.

    It definitely does NOT state that there is any benefit to any alternative medicine.

    .

  17. #17 Militant Agnostic
    August 7, 2012

    @Narad

    It’s a day-counting system, so leap years are irrelevant. All that matters is the assumed start date of the baktun.

    Due to the large gap between the collapse of Mayan civilization and the arrival of Europeans in the region, there is a large margin of error in synchronizing the Mayan and Gregorian calenders. The Debunking Pseudoastronomy Podcast has covered this in great detail. I highly recommend it – his latest was on Velikovksi and he will be doing the “Iron Sun” soon.

  18. #18 Sigivald
    August 7, 2012

    “Wellness”.

    Does that term ever not signal woo?

  19. #19 Paul Browne
    UK
    August 7, 2012

    Cancer Research UK have a good post on their Science Update blog about what the new research means, and what it doesn’t.

    http://scienceblog.cancerresearchuk.org/2012/08/06/headlines-about-backfiring-chemotherapy-are-misleading/

  20. #20 Denice Walter
    August 7, 2012

    @ Paul Browne:

    And no sooner does news like this break, you can be assured that woo-meisters will put their own unrealistic spin on it ( e.g. MIke Adams, today @ Natural News; a few days ago, about mammography) exaggerating the risks of SBM, failing to mention the benefits and linking to their own detritus, i.e. articles that scare people off of SB treatments and diagnostics.
    Endlessly.

  21. #21 Narad
    August 7, 2012

    Due to the large gap between the collapse of Mayan civilization and the arrival of Europeans in the region, there is a large margin of error in synchronizing the Mayan and Gregorian calenders.

    Yes, I understand that linking the systems is a challenge. Still, no leap years.

  22. #22 palindrom
    August 7, 2012

    Militant Agnostic @415 — When I’m not goofing off writing comments, I’m an astronomer.

    In my not-so-humble-opinion, the “iron sun” hypothesis is crank science at its finest. Followed closely by the “electric universe”.

    To paraphrase a moment of Bible parody from the immortal Firesign Theater (“Everything You Know is Wrong!”, 1975), they know not their holes, from an ass on the ground.

  23. #23 THS
    sunny afternoon
    August 7, 2012

    I like the Firesign Theater reference!

  24. #24 Militant Agnostic
    August 7, 2012

    @palindrom
    Isn’t there a large overlap between the iron sun whackaloons and the electric universe whackaloons?

    I can see how someone could become a moon landing denialist or a Planet Xer, or even a Velikovski believer, but the iron sun thing is just so “out there” – it is one those things that makes a person wonder how they hell anyone could come up with such a crazy idea.

  25. #25 palindrom
    August 8, 2012

    MA @ 10:27 PM —

    Yes, I think there’s a fair amount of overlap.

    All the characteristics of the crankosphere are there, in particular complete ignorance of, and dismissal of, reams and reams of countervailing evidence. As far as they’re concerned, a century of development in spectroscopy, stellar atmospheres, stellar interiors, nuclear physics, and so on and so on — might never have happened.

    My usual question to these folks is to ask them to explain a globular cluster color-magnitude diagram from first principles using their precepts. They don’t even know what I’m talking about, even though this has been bread-and-butter observational astronomy for at least 50 years.

    Like all conspiracy theorists, they’re obsessed with minor details which are either easily explicable in rational terms, or (in rare cases) easily written off as bad data. Almost any scientist will tell you that knowing what data to ignore is an important part of being a good scientist, though we usually don’t advertise this.

    I could go on, but you get the picture.

  26. #26 Interrobang
    August 8, 2012

    What is the “Iron Sun” thing? I’d Google it, but I’m too scared of what I’d find.

  27. #27 lilady
    August 8, 2012

    “The 2012 Assembly will commence with a captivating, inspirational keynote address….”

    Stop…right…there. Sounds like a religious revival meeting opening remarks by a sinner who found Jesus.

    Take a look at this gem, located within the AAFP Policy Statements:

    http://www.aafp.org/online/en/home/policy/policies/c/complementarypractice.html

    “The AAFP advocates for the evidence-based evaluations of integrative medicine (also referred to as complementary and alternative medicine (CAM) treatments and practices, using scientific and ethnographic methods, including quantitative and qualitative outcomes research of efficacy and effectiveness. When examining integrative medicine methods from different traditions, considerations for cultural perspectives and explanatory models should be made during the design and conduct of the research and for the interpretation of results.

    To this end, the AAFP believes that physicians can best serve their patients by recognizing and acknowledging the availability of integrative medicine in their communities. Furthermore, family physicians can pursue education relative to non-conventional methods of healing to better facilitate appropriate education, treatment and counseling of patients and consumers. (1997) (2009 COD)”

  28. #28 palindrom
    August 8, 2012

    Interrobang @12:34 — The iron sun is a hypothesis pushed by Oliver Manuel, a retired professor from U. Missouri and Rolla (and someone with an, uh, interesting personal history, let’s say). He believes the sun is made of iron and is the remnant of a supernova explosion. Any competent astrophysicist can produce at least a dozen conclusive — you might say, ironclad — arguments against this, but of course, it makes no difference. Manuel supports his argument by making weirdly off-point arguments about detailed isotopic abundances of the heavy elements (he’s a retired nuclear chemist) all the while ignoring the fact that his ideas cannot possibly explain the real sun.

    Conspiracy theorists are often like this. Moon-landing hoaxers focus on niggly details of photographic interpretation (which they don’t understand at all) to “prove” the pictures were faked, all the while ignoring the mountain of evidence that we actually did go to the moon, such as the Saturn V launches witnessed by thousands of people. The totality of evidence is such that it would have been much easier to go to the moon than to fake it all.

  29. #29 Dangerous Bacon
    August 8, 2012

    I wonder if the AAFP “Scientific” Assembly will feature any promotions or giveaways involving the products that Weil sells and endorses.

    For instance, women attending the meeting could be given goodie bags containing Dr. Weil’s “Plantidote Mega-Mushroom Skin-Calming Face Mask”. Or for the guys, “Weil’s Juvenon Anti-Aging Support”.

    Have some woo with that science, doctor?

  30. #30 herr doktor bimler
    August 8, 2012

    Note from the Off-Topic department:
    Dr Christopher Shaw, a person of interest to RI for his central role in the “vaccines contain ALUMINIUM!” story, has appeared in the NZ press:
    http://www.stuff.co.nz/dominion-post/news/7437620/Teens-brain-tissue-sent-for-examination

    The story involves a teenager who died of idiopathic heart failure a while ago, six months after receiving a Gardasil injection; the mother is convinced that the Gardasil was responsible for the girl’s health problems (rather than the Depo Provera she had also received), and has had brain tissue sent to Dr Shaw for his unbiased conclusions that aluminium in the injections causes heart failure.

    I am old enough to remember when Depo Provera was the nexus of moral panics and health hysteria, while vaccines were completely off the radar.

  31. #31 jake
    August 8, 2012

    Hey, what a surprise!!!
    Chemo actually helps cancer grow!!!
    I think that Orac should do a piece about this one:
    http://ca.news.yahoo.com/chemotherapy-backfire-boost-cancer-growth-study-164516832.html

  32. #32 novalox
    August 8, 2012

    @jake

    You do know that what you state isn’t what the research article was actually talking about.

    The article states that the healthy cells around a tumor cell develop resistance to chemotherapy by secreting a protein due to damage from chemotherapy. Since the research group have found this protein, they now may be a way to disrupt this protein or to limit the damage to the surrounding healthy cells.

    Nowhere in the article state anything about chemotherapy directly causing tumor growth, nor does it state that chemotherapy is useless, like you have implied.

  33. #33 Science Mom
    http://justthevax.blogspot.com/
    August 8, 2012

    The story involves a teenager who died of idiopathic heart failure a while ago, six months after receiving a Gardasil injection; the mother is convinced that the Gardasil was responsible for the girl’s health problems (rather than the Depo Provera she had also received), and has had brain tissue sent to Dr Shaw for his unbiased conclusions that aluminium in the injections causes heart failure.

    Considering Dr. Shaw isn’t a medical doctor and no experience as a medical examiner nor pathologist and has a one-track mind regarding aluminium, his conclusions should serve as rather enlightening blog fodder. The notable exception being his doing so off of the tragic death of a young woman and validating a mother’s irrational fears. What a slimeball he is.

  34. #34 herr doktor bimler
    August 8, 2012

    What a slimeball he is.
    It’s not as Dr Shaw instigated the whole story. The mother went off the deep end, probably educated herself at Google University, and decided to hold Gardasil responsible for her daughter’s death — then decided to consult Shaw and have her beliefs confirmed.

    The mother has, for instance, rejected any suggestion that the rest of her family should be checked for idiopathic heart disease — what with her daughter’s death from unexplained heart failure — for fear of disconfirming her beliefs. She has explained, loudly and repeatedly to local media. that there is no history of heart disease in her family, if you don’t count her daughter dying.

    Dr. Shaw [...] has a one-track mind regarding aluminium
    He seems to be anti-everything else in vaccines, too. Any adjuvants = EVIL. He can be found, for instance, decrying polysorbate-80 in vaccines.

    One of the ironies in this story is that (as noted) the dead girl had been receiving Depo-Provera. And if you look up the ingredients of Depo-Provera, there it is… the dreaded Polysorbate-80 (along with Macrogol, i.e. polyethylene glycol, that other item from antivax demonology). But Shaw and the mother have no issue with it there.

    I await Shaw’s findings with interest, and also his explanation of why any abnormalities he finds should be ascribed to Gardasil and not to any of the other vaccinations the young woman had previously received.

  35. #35 herr doktor bimler
    August 8, 2012

    But wait, there’s more! The grieving parents have brought in Dr San Hang Lee, with his test for HPV virus that never fails to find it.
    http://www.stuff.co.nz/dominion-post/news/7445193/Foreign-DNA-found-in-teenagers-blood

    The news item describes Dr Lee as working for the Milford Medical Laboratory. Imma guessing that the coroner was not told that the Laboratory terminated Lee’s employment in 2010.

  36. #36 Science Mom
    http://justthevax.blogspot.com/
    August 8, 2012

    HDB, Shaw is to “testify” tomorrow. It is sad that the mother refuses to seek answers for her daughter’s death but would rather seek a way to blame a bogeyman. Shame on Shaw for accomodating an obviously desparate parent’s false quest. His “findings” will be, at best embarrassing for himself but for different reasons regardless of what he “finds”. He has zero expertise in such matters and I doubt his “testimony” will be given any weight. I wonder who paid for his expenses?

  37. #37 Chris
    Neither here nor there...
    August 8, 2012

    herr doktor bimler:

    She has explained, loudly and repeatedly to local media. that there is no history of heart disease in her family, if you don’t count her daughter dying.

    Well their family would not be the first to lose a child to an idiopathic heart condition, and to not have a history in their family. I noticed that there are several foundations for this, some that I found:
    Sudden Cardiac Arrest Foundation
    Children’s Cardiomyopathy Foundation
    Nick of Time Foundation

    I have a kid with one of the more common conditions that causes sudden cardiac death. We were fortunate in that it caused a loud murmur which lead to an echocardiogram. He is now in cardiac rehab after open heart surgery to remove the excess heart muscle that would block his aortic valve if his heart beat too much (during a stress test his blood pressure went down).

    The genetic screening did not find any of the known genetic causes (but more are being found all the time). The family history is too fuzzy to see if this has occurred to anyone else. Later this month the entire nuclear family goes in for echocardiograms, because the abnormal muscle growth can happen into a person’s sixties.

    Whatever she does, the mother of the unfortunate young lady should have herself, her husband and the rest of her kids screened for heart disease. And there are many, from Long-QT, Short-QT, Marfan Syndrome, dilated cardiomyopathy and on and on, and those are only the genetic ones. There are also a host of issues that happen when a viral or bacterial infection latches on to a heart valve.

  38. #38 herr doktor bimler
    August 8, 2012

    From the Dom-Post story linked above:

    Her parents, Joe and Rhonda Renata, believe her death was a result of her having three injections of Gardasil, the vaccine for cervical cancer in 2008 and 2009.

    I tempted to write them a letter to point out that Gardasil was also the vaccine for cervical cancer in 2010, 2011 and 2012.

  39. #39 lilady
    Just back from wallowing at the SaneVax website
    August 9, 2012

    As I recall the folks at SaneVax are keeping records of all the girls who died *sometime* after receiving Gardasil vaccine and touting the blood test developed by Dr. Sin Hang Lee:

    http://sanevax.org/?s=jasmine+renata&cat=0

    He’s just recently published in a “Methods in Molecular Biology volume..

    http://www.springerlink.com/content/k3lg7125p7024447/?MUD=MP#section=1094370&page=1

  40. #40 ken
    August 9, 2012

    @novalox -You are wrong
    “The expression of WNT16B in the prostate tumor microenvironment attenuated the effects of cytotoxic chemotherapy in vivo, promoting tumor cell survival and disease progression.
    http://www.nature.com/nm/journal/vaop/ncurrent/full/nm.2890.html

  41. #41 herr doktor bimler
    August 9, 2012

    The iron sun is a hypothesis pushed by Oliver Manuel, a retired professor from U. Missouri and Rolla (and someone with an, uh, interesting personal history, let’s say).
    – Last I heard, he was jumping aboard the climate-change-denial bandwagon.

  42. #42 novalox
    August 9, 2012

    @ken

    What I was saying to jake was that his implication that chemotherapy was ineffective because it can cause health cells to produce growth factors is incorrect. Plenty of clinical trials and years of use in patients show that chemotherapy can help in the treatment of cancer. What the paper is identifying is a pathway in which healthy cells surrounding a tumor can secrete a protein that can cause cancer and tumor cells to grow when exposed to chemo.

    Unlike jake above, who implies that this is bad thing only, I think that it might actually be good. Scientists and doctors know that tumors can sometimes grow or come back after treatment and become resistant to chemo. Now that one of the pathways to this resistance is known, scientists and doctors can explore this process more in depth, find ways to block or interfere with this pathway, developing more effective ways of treatment.

    Another thing about the study was that it was done in lab cultures, using specific types of cancer cells and specific types of cancer drugs. Yes, one pathway was found in a specific type of prostate cancer cells. It doesn’t mean that this pathway would be the same in different types of cancer cells.

  43. #43 palindrom
    August 9, 2012

    Herr Doktor Bimler @ 1:38 — Thanks for the link.

    I find the fact that Manuel has been embraced by the climate-change denialist community to be unsurprising — one crank theory after another is paraded as the “final nail in the coffin of global warming” by these folks, showing for the zillionth time that many of them know nothing and in particular would not recognize good science if it came up and bit them in a sensitive place.

  44. #44 ArtK
    Avoiding the WNT16B draft
    August 9, 2012

    @ken (and @jake)

    What I read from the abstract is that in some circumstances, cancers (or the immediately surrounding healthy cells) can develop resistance to chemo. That in no way says that chemo promotes cancer growth — that’s a big logic fail to draw that conclusion. “Promoting cancer growth” would mean that after administering chemo, the cancer grew bigger than it would have if chemo had not been administered. I don’t see where the article is saying that. “Promoting survival” is not the same as “promoting growth. “Enhance subsequent resistance” is not the same as promoting growth. ” Frankly “allowing” would have been better than “promoting” in this case.

    That would be exactly like saying antibiotics promote infection because bacteria can develop antibiotic resistance.

    Another analogy: There’s a big difference between slowing something down and reducing its acceleration. Colloquially, people may call both “slowing,” but in the second case the object could still be going as fast or faster; it’s just not getting faster at the same rate.

  45. #45 jake
    August 9, 2012

    @ novalox:
    Really??? I implied that chemotherapy is worthless???
    I would never say that considering that I have a friend that was treated successfully with his testicular cancer with chemotherapy. It is known to be very successful with a few cancers and not very successful with most cancers.
    Also, as the articles states:
    “Our results indicate that damage responses in benign cells… may directly contribute to enhanced tumour growth kinetics,” wrote the team. ENHANCED TUMOUR GROWTH KINETICS….sounds to me like the chemo is helping the tumours grow once the proteins are secreted???

  46. #46 AdamG
    August 9, 2012

    jake,
    You can’t generalize the very specific results regarding the effect of a specific chemotherapy agent on a specific tumor subtype to say “sounds to me like the chemo is helping the tumours grow”

    It’s also a complete distortion of the author’s findings. There is no chemo-induced growth, merely a failure of the chemo to prevent tumor cell repopulation (figure 6g illustrates this model beautifully). This is an important distinction.

  47. #47 flip
    August 10, 2012

    @Militant Agnostic

    Thanks for introducing me to Debunking Exposing Pseudoastronomy!

  48. #48 jake
    August 10, 2012

    @ Adam: I’m not generalizing. I realize that it doesn’t apply to all cancers but the fact is that in this case the chemo eventually helped the tumors grow by causing the “good cells” to secrete this protein. Nevertheless, it is a great find and hopefully it will lead to much better drugs. It is disappointing that it took this long to find this out as this effect has been know for many years.

  49. #49 jake
    August 10, 2012

    @ Adam: Also, the article did say that the study was replicated on 2 other cancers.

  50. [...] not. I first became aware of part one of this particular story back in August. This time, as I pointed out a couple of months ago, it’s the American Academy of Family Physicians that has failed utterly, abjectly, and [...]

  51. [...] was not the only one to object. Back in August, Orac also criticized the AAFP for selecting Weil.  The Institute for Science in Medicine wrote a letter to the AAFP and received an answer with [...]

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