I saw this story on Friday and almost couldn't wait the weekend to blog about it. However, since the conference that was brought to my attention isn't until November, I ultimately decided that it would keep. At least until now.
This story is about Francis Collins, the director of the National Institutes of Health. Unlike some bloggers, personally, as a physician and scientist I don't much care about what religion Dr. Collins ascribes to. Unlike some writers such as Sam Harris, most definitely do not consider his strong Christian faith a disqualification for holding the position that he now holds. All I care about in an NIH director is how well he or she shepherds the scientific mission of the NIH and runs the organization. As a supporter of science-based medicine, I just want the NIH to fund and support only the most rigorous science and to be a well-run organization. Thus far in Dr. Collins' tenure, I haven't seen any anything major to worry about on that score, although I have had some disagreements with Dr. Collins' five themes for the NIH.
Recently, however, I was very disappointed to discover that Dr. Collins will be the keynote speaker at the 8th International Conference of the Society of Integrative Oncology (SIO) in November. I rather suspect that he didn't know just what it is that what he was accepting or what the Society for Integrative Oncology is, other than a professional society. At least, I hope that is the case. From my perspective, "integrative oncology" is a discipline that, at its core, is dedicated to "integrating" pseudoscience with science, and by agreeing to speak to the SIO Dr. Collins will be unwittingly providing it with the imprimatur of his position as NIH director.
To se what I'm talking about, it's time to revisit the whole discipline of "integrative oncology." So, what is "integrative oncology" and why does it concern me as a cancer surgeon and researcher? I have already discussed this particular in extreme detail, referring to it as quackademic medicine victorious, and so it is. On multiple occasions, I've also referred to "integrative oncology" as a "Trojan horse" that is allowing pseudoscience to infiltrate medical schools and academic medical centers. Here's what I mean. Whenever you see discussions of "integrative medicine" and in particular "integrative oncology," chances are, the modalities under discussion will usually focus primarily on various dietary changes and lifestyle interventions, such as exercise. Often recommended exercise comes in the form of yoga, tai chi, and other disciplines that tend to be infused with concepts from Eastern mysticism, such as qi ("life energy"). Other modalities featured often include herbal remedies. In other words, "integrative oncology" in essence "rebrands" modalities that have no reason not to be counted as part of science-based medicine as being somehow "alternative" or "integrative" and points to them as having some promise. After all, if you strip away the Eastern mysticism from yoga and tai chi, among others, all you have left is low impact exercise, and there is no reason to consider low impact exercise to be anything "alternative" or "integrative." Exercise and diet are within the purview of science-based medicine. Herbal remedies are nothing more than a rebranding of the perfectly science-based subdiscipline of pharmacology known as pharmacognosy. Advocates of CAM/IM then lump together pseudoscience like reiki, "therapeutic touch, acupuncture, naturopathy, and even homeopathy with sensible lifestyle interventions, such as diet and exercise, making the association that, if diet and exercise are "alternative" and work, so, too, do modalities that can at best be considered quackery, such as homeopathy.
Perhaps the best place to begin is with the SIO's very own practice guidelines. These guidelines represent a masterful package of rebranding of perfectly science-based modalities, such as lifestyle interventions and changes in diet, which are then tied to "energy healing" quackery as if there were an equivalent evidentiary basis to support them. For instance, some of the recommendations of the SIO are, as Dr. Atwood put it, embarrassingly obvious. For example, here are a few selected guidelines to show you what I mean:
- Recommendation 1: Inquire about the use of complementary and alternative therapies as a routine part of initial evaluations of cancer patients. Grade of recommendation: 1C
- Recommendation 6: The application of deep or intense pressure is not recommended near cancer lesions or enlarged lymph nodes, radiation field sites, medical devices (such as indwelling intravenous catheters), or anatomic distortions such as postoperative changes or in patients with a bleeding tendency. Grade of recommendation: 2B
- Recommendation 7: Regular physical activities can play many positive roles in cancer care. Patients should be referred to a qualifi ed exercise specialist for guidelines on physical activity to promote basic health. Grade of recommendation: 1B (1A for breast cancer survivors post-therapy for QoL)
- Recommendation 15: It is recommended that patients be advised regarding proper nutrition to promote basic health. Grade of recommendation: 1B
What is "alternative" about any of these recommendations? Nothing. Physicians routinely ask what supplements or "alternative" therapies their patients are using. It's simply mind-numbingly obvious common sense not to use deep massage or pressure near cancer lesions, enlarged lymph nodes, radiation field sites, or near medical devices, such as Portacaths or other indwelling implantable devices. What physician would not recommend proper nutrition or regular physical activity, as much as the patient can tolerate, under the guidance of an exercise specialist? Then, coupled with the above sensible recommendations, we find this:
- Recommendation 3: Mind-body modalities are recommended as part of a multidisciplinary approach to reduce anxiety, mood disturbance, chronic pain, and improve QoL. Grade of recommendation: 1B
- Recommendation 8: Therapies based on a philosophy of bioenergy fields are safe and may provide some benefi t for reducing stress and enhancing QoL. There is limited evidence as to their effi cacy for symptom management, including reducing pain and fatigue. Grade of recommendation: 1B for reducing anxiety; 1C for pain, fatigue, and other symptom management
I find it most interesting to note what the SIO considers "1B" evidence:
Strong recommendation, moderate-quality evidence
How on earth can one reasonably make a "strong recommendation" on "moderate-quality" evidence, even assuming one agrees that the evidence is "moderate-quality"? The SIO defines "moderate quality" evidence as:
RCTs with important limitations (inconsistent results, methodological flaws, indirect, or imprecise) or exceptionally strong evidence from observational studies.
Confusingly, the SIO makes "strong recommendations" based on "moderate" evidence (level 1B). In other places, it makes "strong recommendations" based on "low or very low quality evidence" (level 1C). Doesn't it make you wonder why the SIO decided to make up its own categories of evidence, rather than use accepted evidence-based medicine (EBM) categories of evidence? Certainly, I wonder. I also wonder how the SIO could categorize instructing patients "regarding proper nutrition to promote basic health" as only category 1B.
As for other recommendations made by the SIO, rating the evidence for "energy healing" methods--or, as the SIO calls them, "therapies based on a philosophy of bioenergy fields"--as grade 1B vastly overestimates the quality and quantity of evidence in favor of "energy healing" methods. "Energy healing" is quackery, based as it is on an unproven concept that there is an "energy field" or a "life energy" that can be manipulated by practitioners for therapeutic intent. Never mind that no scientist has ever been able to measure or detect these "energy fields," find convincing evidence that they exist, or verify that practitioners can actually manipulate them to therapeutic purpose. Never mind that the very concept is based on a vitalistic, pre-scientific understanding of how the human body works and how disease develops. I note that "energy healing" methods also include acupuncture, whose premise is that sticking needles into the skin can somehow alter the flow of this life energy to healing effect. I also note that the totality of evidence regarding acupuncture is that it does no better than placebo when tested in well-designed randomized clinical trials. It doesn't matter where the needles are placed or even whether the needles are placed. Indeed, even twirling toothpicks against the skin works as well as needles. Just type "acupuncture" in the search box of this blog, and you will be deluged in posts that (hopefully) will tell you all you need to know. Meanwhile, acupuncture apologists publish papers in which fanciful physiological mechanisms by which acupuncture allegedly works are proposed and poorly supported with evidence.
I note that the title of Dr. Collins' talk is "Faith, Spirituality and Science in Oncology." I find this unsurprising, because in the world of "alternative" medicine"--or whatever you want call it, be it "complementary and alternative medicine" (CAM) or "integrative medicine" (IM)-- religious faith, "spirituality," or whatever you want to call it, is often co-opted to serve quackery in a manner very similar to the manner in which diet and exercise have been co-opted. Reiki is an excellent example of this. It is one of the more prevalent of CAM/IM modalities, and it is currently being extensively used in cancer, even though the evidence base for it is virtually nonexistent. I have in the past referred to reiki as faith healing that substitutes Eastern mystical beliefs for Christian beliefs, and that is an accurate description. Consider: What is faith healing? It's the belief that a healer can channel the power of God into the ill to heal them. Now what is reiki? Reiki involves channeling "energy" from what reiki masters call the "universal source" into the ill to heal them. Like faith healers, who assert that the power doesn't come from them but from God, reiki masters assert that the power doesn't come from them but rather from the "universal source." Indeed, the founder of reiki, Dr. Mikao Usui explicitly patterned reiki on how Jesus healed:
Dr. Usui was a Christian minister in Japan, though Japanese. He was the head of a Christian Boys School in Japan. One day some of the students asked him if he believed in the miracles which Jesus did (healing, etc). Being a Christian minister he answered "Yes". They asked if he knew how Jesus had done this, "No" he said...
With this he resolved to find the way in which Jesus had healed. This immediately set him on a journey of many years. Studying first at Christian schools in the US, for where else to learn of Jesus, but with no results. In the Christian schools the method was not known.
Dr. Usui even subjected himself to a 21 day fast on a mountain that very much resembled Jesus' 40 days and 40 nights in the wilderness, after which we have this description:
After returning from this experience he began back down the mountain and was, from this moment on, able to heal. This first day alone he healed an injured toe, his own starvation, an ailing tooth and the Abbots sickness, which was keeping him bedridden. These are known as the first four miracles.
Should science- and evidence-based medicine be concentrating on miracles and faith healing? I certainly don't think so. Yet that is what most "energy healing" modalities (reiki, therapeutic touch, and, yes, acupuncture) boil down to, when stripped of all the "science-y" language used by apologists to justify them. If you don't believe me that at the very core of reiki is religion, consider this. In 2009 the U.S. Conference of Catholic Bishops warned Roman Catholics to shun the eastern healing art of reiki because it's dangerous to Christian spiritual health. Some Christians even view reiki as a sin. Moreover, huge swaths of other CAM/IM modalities are based on similar beliefs that are rooted in faith, spirituality, and even outright magic. The common CAM/IM modality of homeopathy, for example, is based on the concepts of sympathetic magic, and naturopathy, which many SIO practitioners recommend, requires homeopathy as part of its training, which is why many naturopaths are also homeopaths. The bottom line is that, no matter how much naturopaths try to defend themselves as being "scientific," the entire discipline is anything but.
It appears to me that the SIO is trying to take advantage of Dr. Collins' well-known religious faith in order to use his reputation as a scientist and as NIH director to claim for itself the mantle of scientific respectability that it does not merit. Instead of the usual "bait and switch" rebranding science-based modalities such as diet and exercise as "alternative," the SIO is now rebranding religion and spirituality as somehow being "alternative medicine." Because Dr. Collins is the only person who can represent the entire NIH, not just a single center in the NIH or an office in one institute in the NIH, which is why I'm so disturbed that he has agreed to speak at an organization that promotes the infiltration of quackademic medicine into medical schools. Cancer patients deserve the best in science- and evidence-based medicine. Unfortunately, "integrative" oncology" is nothing of the sort. It adds nothing to cancer care other than the rebranding of sensible treatments as "alternative" and the "integration" of unscientific, unproven, and potentially harmful "alternative" treatments with science-based treatments. Cancer patients deserve better.
Finally, I've criticized two institutions of the NIH for promoting and funding unscientific research, quackery even. These institutions include the National Center for Complementary and Alternative Medicine (NCCAM) and the National Cancer Institute's (NCI) Office of Cancer Complementary and Alternative Therapy. Between NCCAM and OCCAM, the NIH spends a quarter of a billion dollars a year studying and promoting modalities that range from being sensible science-based treatments, such as diet and exercise, to modalities that can only be described as pure quackery (homeopathy, therapeutic touch, reiki, acupuncture, etc.). When budgets are this constrained, does the NIH have the luxury of spending a quarter of a billion dollars a year, or approximately 1% of the total NIH budget (with OCCAM representing approximately 3% of the total NCI budget) on research that is not only largely made up of either pseudoscience, vitalism, or or magical thinking interspersed with science-based modalities that CAM apologists try to rebrand as "alternative" or "integrative" but exceedingly unlikely ever to benefit patients? NCCAM alone has already spent over $2 billion since its inception in the 1990s and has yet to demonstrate convincingly that even a single "alternative" medicine modality provides concrete benefits greater than placebo effects.
I have no doubt that Dr. Collins wants to shape the NIH into a form that is dedicated to the best possible science we as a nation can support for the money and to promote that science. That's why, in the end, I hope he will realize that speaking at the SIO conference does not serve that end, nor does continuing NIH support for NCCAM and OCCAM. I've said it before, and it bears repeating yet again. The division of medicine into "conventional" and "alternative," "complementary and alternative," or "integrative" medicine is a false dichotomy. There should be only medicine, and the scientific standards for determining what is and is not safe and effective medicine should be the same. Dr. Collins' appearance at the SIO conference this November will only serve to support the false dichotomy that tries to foist unscientific medicine upon cancer patients as "integrative" medicine.
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"I rather suspect that he didn't know just what it is that what he was accepting or what the Society for Integrative Oncology is, other than a professional society. At least, I hope that is the case. From my perspective, "integrative oncology" is a discipline that, at its core, is dedicated to "integrating" pseudoscience with science, and by agreeing to speak to the SIO Dr. Collins will be unwittingly providing it with the imprimatur of his position as NIH director."
I think that's most certainly the case. He is a busy person and will probably give a standardized talk and fly home before he even noticed what it was, if he doesn't get the info before the conference.
By the way, what do you think about this:
http://www.nature.com/nature/outlook/cancerprevention/
specifically the diet and lifestyle articles, s16 and s22.
I rather suspect that he didn't know just what it is that what he was accepting or what the Society for Integrative Oncology is, other than a professional society.
Have to disagree strongly with you and mo. As you say later in the post:
I note that the title of Dr. Collins' talk is "Faith, Spirituality and Science in Oncology." I find this unsurprising, because in the world of "alternative" medicine"--or whatever you want call it, be it "complementary and alternative medicine" (CAM) or "integrative medicine" (IM)-- religious faith, "spirituality," or whatever you want to call it, is often co-opted to serve quackery in a manner very similar to the manner in which diet and exercise have been co-opted.
Simply because Dr. Collins' "faith and spirituality" is Christianity rather than a Far Eastern religion, that doesn't make his take on oncology scientific.
We'll have to wait for his talk to see whether its major thrust is to say spirituality can be a good thing when integrated with a scientific approach, or whether he intends to "beard the lion in his den" and tell the attendees that science must rule. My guess is that as the director of a body that incorporates NCCAM and OCCAM, and conscious of the imperative to make nice to certain Congresspeople in these times of constrained budgets, Collins will couch any criticisms mildly enough to be sure not to offend the conference attendees. However, there will be enough praise of science to cite contra criticisms of a sellout from pro-SBM folks.
But as far as backing off from any imprimatur of respectability his appearance will lend SIO, that horse has left the barn. I'm sure Director Collins knew full well the impact his agreement to appear would have, and that the political calculation behind his decision showed it was more important to curry favor among the "faith-based" than among SBM advocates.
I'm willing to give him the benefit of the doubt. I've met him before and he seemed very much into his science.
Collins believes that God is required to reconcile evolution with human altruism, and to explain cosmic "fine-tuning". Nothing to do with his work at the NIH so perhaps it doesn't matter that outside of his watch he is open to God-of-the-gaps type reasoning. Abandonment of scientific reasoning, that is to say.
Would be interested to know if he believes "miracle" cures can be considered as further evidence for God's existence.
This whole business is pretty sad...quackery is gaining more and more undeserved legitimacy by the day. I can't wait until they reintroduce bloodletting as "an ancient practice for restoring the Qi".
Orac, you seriously don't agree that a "strong Christian faith" should disqualify someone from the highest scientific post in the land?
How can a person who claims to adhere to the scientific method also believe in the biblical version of history? Or do you subscribe to NOMA too?
Jamie - if you read Orac's post, it states quite plainly that he doesn't care about a person's particular set of beliefs, as long as they don't interfere with using strict scientific processes to validate their hypotheses.
Jamie,
I can't (obviously) speak for Orac, but I think part of the problem in having that sort of (dis)qualification is that you would need to define "a strong Christian faith." Bear in mind that there are hundreds of millions of people who identify as Christians, many of whom insist that some, or most, of the others aren't really Christian.
I also suspect that a significant number of people who say they are sincerely Christian are indifferent but playing it safe. Admitting to not being a Christian can make a person unpopular in many parts of the United States. (You can't tell the newspaper you're an atheist and expect your relatives not to find out.)
There are also legal issues:
I'm fairly sure a court would hold that requiring someone not to believe in an Abrahamic religion came under that clause.
CAM, IM, and "spirituality" are considerd *hip* ( although I have no idea how *not* using your brain and being a target for charlatans would make you attractive)- perhaps this is why magazines like the Atlantic kowtow in the direction of nonsense. It's hard to fight "cool".
I spent the late am Sunday observing- without interfering: located at the entrance of a National Seashore, a very small town** caters to the every wish and need of the fashionably woo-entranced. Alt med providers and LMTs abound, as do Pilates studios, photo galleries, organic groceries, and restaurants. A building supply company provides a playground, yoga area, and free restrooms in a park-like setting. Lovely young women shop for linen clothes while mothers calmly instruct their young charges in the ways of natural living.
I overhead 2 men, in full sport bike regalia, heartily disapproving of a colleague's "in-appropriate" references to a young female assistant: "Not cool", one said. Older citizens staged a very mild protest for "peace" on the green.
Sitting amongst the flowers and trees on a natural wooden bench graciously provided by the food merchants, I sipped my gmo-free green tea and asked people nearby for opinions about "what is best to see at the park": only too happy to oblige me, they spent 20 minutes rhapsodising about the wonders beyond the gate and conversing with me. They were so kind. For some reason, I am inordinately acceptable to this crowd- they think I'm one of them- and in a way, I am: white, educated, and (somewhat) affluent. I like some of the same things that they do. I wore my beige sun-protector hat ( looks like something your WASPy uncle would wear on his boat) and have excellent manners.
How do we get through to smart people who mix up fashion and science? The affluent are trend-setters and taste-makers so the nonsense eventually trickles down to everyone. How do we communicate the "ick" factor about what is currently considered desirable?
** Point Reyes Station, CA
@Larry and Vicki,
I told you it's about metaphysical belief not clinical decisions. You are only tolerated so long as you can keep your magic in your box. You are not a congruent SBMer.
@Denice,
So many theories, so many anecdotes, so much confirmation bias, so little evidence.
Orac, you seriously don't agree that a "strong Christian faith" should disqualify someone from the highest scientific post in the land?
I'm with Orac on that one, for two reasons:
- Having grown up Jewish, from childhood I've had a heightened sensitivity to "belief tests" (or in this case lack-of-belief tests).
- The smartest individual I've ever known personally, my best friend as a teenager, a careful and conscientious scientist with a long list of journal publications and multiple experiments on the Hubble telescope, is a committed Christian.
Now that last part doesn't mean to him what it seems to mean to a lot of folks. It means things like the fact that, spending time nearly every day with him for years, I literally never once heard him speak ill of another human being. It means he spends much of his free time as a volunteer building homes for people who can't afford them. It means he takes to heart as real goals the types of things other folks (including, I readily admit, myself) view as trite, pious impossibilities, like "Treat others the way you would want to be treated," and "I am my brother's keeper."
So on the one hand there's the notion that being religious ought to be philosophically contradictory with being a good scientist, and on the other hand I've got long experience with a real human being showing me it's quite possible. Gotta go with actual experience on this one.
Just a quibble -- unfortunately the NIH doesn't get to decide whether it wants to support NCCAM or not. It's an obligation congress has placed on them. However, they could at least try to manage it to be as little obnoxious as possible, which they aren't doing.
This is perhaps the source of the very first metastasis circa 1980: http://www.pennybrohncancercare.org/page15.asp
legitimised by the barking loon heir apparent to the English throne: http://news.bbc.co.uk/1/hi/england/bristol/6904902.stm and http://www.lancet.com/journals/lancet/article/PIIS0140-6736(05)65702-9/….
I doubt there is anything "unwitting" about Collins' decision to speak to this group.
The best face one could put on the decision is that Collins figures it's politically smart to court this constituency, especially since its views are echoed by powerful figures in Congress such as Tom Harkin and Orrin Hatch.
There are devout wooists in Congress, but I've not heard of any influential skeptics.
@ augustine:
If you plug in "vaccine affluent" in the searchbox above- for starters- you will find data about the relationship between socio-economic class and alt med-friendly attitudes: one example being vaccines ( 6/21/11; 8/26/; 3/21/09, etc.) about which Orac has written frequently.
While I'm not about to produce a f--king *dissertation* for your benefit- I have bigger fish to fry- my observations (about the lovely people of PRS, CA and the businesses they support) illustrate common knowledge you can ascertain from watching BloombergTV or CNBC- organic, green, natural, sustainable,"Eastern", and alt med *sell* to folks with the other type of "green" and those who would emulate them.
Many here seem to be forgiving of Collins' past and his present Christianity. This is a man that wrote "Belief: Readings on the Reason for Faith" and "The Language of Life". This is a man who has never shied away from using his supposed credibility to mix science and religion. I've been watching for this kind of evidence ever since he left the Genome Project, expecting that it would pile up higher and higher until it would be absolutely clear about his religious biases. But here I see that many are still willing to apologize for his dalliances, his carefully crafted dance with magic thinking.
He's admitted that the whole reason he worked on the Genome Project was to find "the language of God", or that he was searching for evidence for God and creation.
But this foray into CAM is just another example of how he is in a position that he never deserved, nor does he take his responsibility seriously. I don't think science in general has been helped by this man, but in fact I see it as just the opposite, he's encouraging more woo-ists and religious dogmatists to get into science to do nothing more than go out and attempt to find evidence of a deity.
Denice Walters
There you go again with your visions of grandeur.
Jay--
I don't agree with or approve of what he's doing; I just don't think it's either a good idea or practical to deal with it by drawing a line and saying "Christians aren't qualified" rather than looking case-by-case for magical thinking. (Not practical includes that pesky constitutional issue, as well as the fact that we keep getting Christian presidents.)
@ augustine : and *what* exactly *did* you study in grad school, or was it med or business school?
Statistical analysis 101 called, it said it wanted to get acquainted with you.
@Vicki: I'm not suggesting that his only disqualification should be his Christianity. Collins has displayed massive amounts of unscientific thinking and gives me the impression that he is in it for the credibility. What would be the difference between Francis Collins and Stephen C. Meyer or Michael Behe, or any of the other "scientists" that use their authority to give false credibility to their claims?
How many times has Orac mentioned physicians and scientists that appear to have obtained academic certification only to use the apparent credibility to further personal religious causes? Why is Francis Collins any different? Heck, I think the guy has waved it in our faces with his books, yet I see so many scientific leaders that accept him with open arms. Is it because he's the guy with the checkbook?
JakK, I think you're being a little conspiracy oriented. I think most Christians study medicine or science for straight forward reasons. When they have the qualifications and are doing the work, naturally they will use them to futher their goals, religious and other. Saying you are studying the world to understand God's creation was a standard motivation for research prior to the 20th century. Even with odd expressions, it usually does not mean you will bias the results.
A smaller number are not less straight forward - e.g. young earth creationists studying paleontology are likely to be doing so to attempt to debunk evolution.
Of course outside the U.S.A. most Christians do not buy the young earth creationist, anti-evolution, biblical literalist package.
JayK if Christianity is "a disqualification" to what career level in life sciences should someone in possession of one of these disqualifying traits be permitted to rise?
I thought the swipe on Sam Harris was gratuitous--and false. Harris' objection to Collins' appointment as Director of NIH was fairly mild and was based on his unscientific beliefs concerning the human intellect and ethical capacity. Harris most certainly did not say that Collins' "strong Christian faith" disqualified him.
Attention god/spirit believing sciencebloggers. Don't mix your pharyngula with your Respectful Insolence. Make sure to compartmentalize everything in your life and never let disagreements with your boxes interfere with your oblivious lives.Or you'll find out that you're not a very good skeptic.
Society for Integrative Oncology? Where does the word alternative appear there?
It doesn't because this new 'integrative' twist in no way throws the baby out with the bathwater- all conventional therapies AND complementary/alternative therapeis for which there is an evidence based benefit.
The timber of the argument provided here suggests a more emotional reaction than rational.
@JohnV: I didn't say Christianity is automatically "a disqualification", but Collins spends far too much time evangelizing, his appointment appears to be pushing the boundary between government and religion, by my opinion. I'd rather see someone in the position that keeps their religion private or at least on a minimum while they are representing science. Collins' level of religiosity is the disqualifier, not his mere belief.