When PARADE goes woo

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

Take, for example, PARADE Magazine.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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