The Central Dogma of Alternative Medicine

[Note: My flight home from London was delayed until quite late; so unfortunately another "rerun" is in order. This one's from three years ago, and I actually consider it one of my "classics." It was also originally published at my not-so-super-secret other blog and represents the first time I tried to put together my concept of a "central dogma" of alternative medicine into a semi-coherent form. Ultimately, this lead to my talk The Central Dogma of Alternative Medicine, given at Skepticon last year. If you've been reading less than three years, it's new to you. If you haven't, you really should check it out again. Discuss! There will material tomorrow, finally! I promise!]

There is something in molecular biology and genetics known as the "central dogma." I must admit, I've always hated the use of the word "dogma" associated with science, but no less a luminary than Francis Crick first stated it in 1958, and it has been restated over the years in various ways. Perhaps my favorite version of the central dogma was succinctly stated by Marshall Nirenberg, who said, "DNA makes RNA makes protein," which about sums up all of molecular biology in five words. Or at least it did until the last ten or twenty years, when we've been finding exceptions to this dogma.

I don't want to dwell on the central dogma. As I've said, I loathe the use of the term "dogma" to describe anything in science, although a discussion of the central dogma and its exceptions might make for a decent post one day. What brought the central dogma to mind is a series of articles I saw recently in ONCOLOGY: Perspectives on Best Practices that let me to ponder the question: What is the "central dogma" of "alternative medicine"? I realize that alt-med is an unwieldy gmish of ideas that range from the semi-plausible but unproven to the completely ridiculous (i.e., homeopathy or reiki), but after reading these articles and thinking about it, I do believe that there is in actuality a "central dogma" of alternative medicine. I also believe that it is entirely appropriate to call it a "dogma" in this situation, because it is far more a matter of faith than it is of science. Moreover, the more that quackademic medicine infiltrates academic medicine, the more this "central dogma" has infiltrated academic medicine with it. Indeed, as you will see, when this central dogma is questioned, even by someone sympathetic to "complementary and alternative medicine" (CAM; i.e., "complementing" medicine with quackery) or "integrative medicine" (i.e., the "integration" of pseudoscientific medicine with medicine).

If you want a hint about what I've come to believe that this "central dogma" is, you need go no further than a post by Jim Coyne. Basically, it is a discussion of how poor the evidence is to support the contention that psychotherapy and/or patient support groups increase cancer-specific outcomes, up to and including the prolongation of survival. In other words, whatever the value of psychotherapy or strategies to improve mood or happiness might have in improving the quality of life of cancer patients, there is no good evidence that such strategies improve concrete, objective outcomes, such as patient survival.

Which brings us to what I think to be the central dogma of alternative medicine and "integrative" medicine.

The central dogma: The Secret, or wishing makes it so

Before I deconstruct the articles, let me expound a bit (or more than a bit) upon what I mean by "central dogma." Like molecular biology, alternative/complementary/integrative medicine has a central dogma. Also like molecular biology, this dogma doesn't fit in all situations but is a reasonable rule of thumb to get the basic idea across, after which it becomes easier to discuss exceptions and clarifications. In otherwords, it's a rough scaffolding upon which we can hang the various beliefs, treatments, and ideas that undergird alternative medicine. I'll try to boil it down to as simple a sentence as Marshall Niremberg's statement of the central dogma of molecular biology:

Wishing for healing heals.

Alternatively, it can be stated somewhat more accurately as: You attract health to yourself. Note that this is just like The Secret, only for health.

That's right. The central dogma of many, if not most (if not all) alternative medical systems seems to be that, if you wish for healing hard enough, your mind/spirit/energy can heal you of almost anything, just as, according to the Law of Attraction from The Secret, you "attract" things to you from the universe according to your thoughts, intents, and desires. Of course, in one way, The Secret is trivial in that there is no doubt that if you want something badly enough you will be more likely to take action to go after it and therefore more likely to get it. However, action based on desire is not what The Secret is about; it's about thoughts and attitudes. Two such examples in the infamous movie about The Secret include a man worrying about being late for work ending up getting stuck in a traffic jam and a man locking up his bicycle because he is worried about its being stolen, only to return later to find out that it has been stolen. As stated by Rev. Dr. Michael Beckwith, a version of this idea reads, "It has been proven scientifically now that an affirmative thought is hundreds of times more powerful than a negative thought."

The similarity with much of alt-med should be obvious and embodied in the idea, which I've seen so many times on so many alt-med websites, that you - yes, you! - are completely responsible for your own health by your own lifestyle choices. Anyone who's read this blog (or my other, super not-so-secret blog, or Steve Novella's blog, or the blogs of any of our other regular contributors) has almost certainly seen discussions of claims that all it takes is living the right way, doing the right things, and you can be not just healthy, but virtually immune to serious diseases up to and including cancer. This sort of concept is inherent in the antivaccine world, in which it is frequently stated that vaccines are unnecessary because healthy people don't get sick. One famous example of this was Bill Maher stating that he can't get the flu on an airplane because he lives the right lifestyle and keeps himself free of "toxins." It's also inherent in the germ theory denialism so common in alt-med systems such as naturopathy and homeopathy. This denialism most often takes the form of the 21st century embrace by antivaccinationists and alternative medicine mavens of a hypothesis from the 19th century by Antoine Béchamp that it is the "terrain," not the microbes, that make us sick. Never mind that in the influenza pandemic of 1918 it was the younger people who tended to die at a higher rate and the pandemic got its start in the U.S. in a military barracks. The basic concept is that the terrain is all, and, of course, you control the "terrain" with your thoughts.

As with The Secret, there is a germ of truth in the concept that your thoughts can make you healthy, just not in the way it's stated or implied by alt-med practitioners. Again, if you have a genuine desire to be healthy, it is more likely that you will exercise, lay off the unhealthy habits such as drinking to excess or smoking, and eat a healthy diet. However, as reasonable people know, it's a matter of probabilities; diet and a healthy lifestyle are no panacea. Worse, the corollary of the central dogma appears to be that if you are ill it is your fault for not having the right "intent," attitude, and thoughts and therefore not doing the right things and/or not believing hard enough.

We see strains of this sort of thought in many types of alt-med, from traditional Chinese medicine, to naturopathy, to the quantum flapdoodle promoted today by people like Deepak Chopra, for whom "intent" is all, so much so that he even named his blog "Intent Blog" and has for years been touting a "universal quantum consciousness" that you can influence with your thoughts to bring healing to yourself. The same sorts of ideas are found in other areas, for instance in What the Bleep Do We Know?, a movie that abuses quantum physics to argue that we literally create reality with our thoughts. The implication, of course, is that our thoughts create health or disease, because that is a big part of reality for each and every one of us.

Think I'm exaggerating? Well, then. Let's go to the articles.

Barrie Cassileth questions the Central Dogma

Barrie Cassileth is a major figure in the "integrative" medicine movement that has been insinuating itself into academic medicine, as befits her position as the chief of the integrative medicine service and current holder of the Laurance S. Rockefeller Chair in Integrative Medicine at one of the greatest cancer centers in the world, Memorial Sloan-Kettering Cancer Center and her having founded the Society for Integrative Oncology, a specialty and society about which I've complained about on more than one occasion. It was thus a pleasant surprise when I saw that she had written an article for ONCOLOGY: Perspectives on Best Practices entitled Cancer Quackery: The Persistent Popularity of Useless, Irrational 'Alternative' Treatments. Yes, Dr. Cassileth actually uses the word "quackery" in the title and in many parts of the article.

In this article, Cassileth provides a rather standard discussion of bogus cancer treatments that almost could have been written by yours truly, were it not for the complete and utter lack of snark, even the subtle snark that academics sneak into papers. Cassileth does, however, complain that quacks have appropriated the term "complementary" in order to "use it [the term] incorrectly." This complaint derives from how many cancer quacks don't actually advocate using their nostrums in addition to conventional therapy but rather in lieu of science-based medicine. Personally, I find this amusing, given that promoters of quackademic medicine have no one to blame but themselves for this development, given the specific modalities they have tried to "integrate" with science-based medicine. It rather reminds me of the "intelligent design" creationists, craving respectability and crowing to high heaven that they aren't pseudoscientists but real "scientists," taking umbrage at being lumped together with fundamentalist creationists who believe that the earth was created 6,000 years ago with all animals in their current forms. No, Cassileth seems to be saying, we don't associate with that riff-raff. They're fundamentalist loons. We're scientists!

I'll give Cassileth some credit for this article, though, and why not? Cassileth lists a fairly standard bunch of quack treatments, the majority of which have been covered on this blog at one time or another, and rips into them. The litany should be familiar: laetrile, shark cartilage, Entelev/Cantron, various oxygen therapies (such as hyperbaric oxygen or various means of administering hydrogen peroxide, "energy therapies," which Cassileth admits have no evidence to support them. Her article is actually pretty good, by and large, although even though I must concede that I found it a little hard to ignore that she is in charge of overseeing quackademic medicine at one of the greatest cancer centers in the world.

Now here's the statement that got Cassileth into trouble with her erstwhile allies:

Many alternative approaches to healing are premised on the concept of the mind/body connection, and specifically on the theory that patients can harness the power of their mind to heal their physical ills.[4] Many mind/body techniques, such as meditation and biofeedback, have been shown to reduce stress and promote relaxation, and are effectively and appropriately used as complementary therapies today. However, some proponents of these techniques overpromise, suggesting that emotional stress or other emotional issues can cause diseases like cancer and that correction of these deficiencies through mind-body therapies can effectively treat major illnesses. Such claims are unsupported.

Many of these ideas were promoted by a former Yale surgeon, a popular author who advocated special cancer patient support groups in his books. The importance of a positive attitude was stressed, as was the idea that disease could spring from unmet emotional needs. This belief anguished many cancer patients, who assumed responsibility for getting cancer because of an imperfect emotional status. Among alternative modalities, the mind/body approach has been especially persistent over time, possibly in part because it resonates with the American notion of rugged individualism.[4]

Cassileth is correct that there is no compelling clinical or scientific evidence evidence that these therapies impact the natural history of cancer to produce a survival benefit (I note that Dr. Coyne will be publishing more blog posts to explain in detail why), and I have to give her props for carpet-bombing the quackery that is the German New Medicine (and let's not forget its bastard offspring, Biologie Totale). These are cancer quackeries that at their heart claim that cancer is a reaction to "unresolved psychological conflicts" and that curing cancer requires resolving these psychological conflicts. In other words, to the German New Medicine, cancer is a disease of the mind, and the "mind-body" connection is the only thing that can "heal" it. In fact, aside from her excessive credulity towards acupuncture, there's little in Cassileth's article that would trouble most skeptics and promoters of science-based medicine overmuch. However, her two paragraphs that I cited above apparently did much trouble her fellow travelers in the "integrative medicine" movement promoting quackademic medicine. This is evidenced by the editors' decision to accompany her article with not just the usual single commentary, but rather with two commentaries, both of which castigated Cassileth primarily for her statement above about mind-body "healing."

The Central Dogma strikes back

Of the two articles criticizing Cassileth for her heresy, the first is less harsh; so I'll start with that one. It is by a radiation oncologist and practitioner of "integrative oncology" who was not explicitly mentioned by Cassileth in her article, Brian D. Lawenda, MD. According to his practice's website, it appears that he happily refers patients to receive all manner of "integrative services," including acupuncture, reiki, and herbal medicine. (I was relieved not to see homeopathy on his list.) In this video segment (beginning at around 19:30), he is introduced as a "radiation oncologist, integrative oncologist, and medical acupuncturist" and discusses the "anticancer diet." I hate when that sort of term is touted as being somehow part of "integrative medicine"; all it is (and, to be fair, all Dr. Lawenda says that it is) is a healthy diet along with exercise. It's science-based medicine, pure and simple, nothing "alternative" or "integrative" about it!

But enough. Let's take a look at Dr. Lawenda's editorial, Quackery, Placebos, and Other Thoughts: An Integrative Oncologist’s Perspective, in which, besides touting unproven placebo therapies like acupuncture, he remonstrates with Cassileth over her characterization of "mind-body" medicine:

One area of controversy that comes up often in integrative oncology circles is whether or not there is an association between chronic stress and cancer-specific outcomes. Dr. Cassileth asserts that the association between chronic stress and cancer development, progression, and recurrence has not been definitively established. Those who support this view might categorize as quackery the claim that stress reduction (eg, through lifestyle changes, mind-body therapies, etc) can improve cancer-specific outcomes.

Those who believe that chronic stress and cancer are linked cite data that support this claim. In particular, there are clinical studies [7] that report improvements in cancer-specific outcomes in patients who are taught stress management techniques. Furthermore, researchers continue to identify chronic stress as a causative factor in numerous pathophysiologic processes that are known to be associated with the development, progression, and recurrence of various cancers (eg, stimulation of systemic inflammation and oxidation, impairment of immune function, increases in insulin resistance and weight gain, etc).[8]

Lawenda overstates his case massively. The evidence that improving "attitude" improves cancer-specific survival is of shockingly low quality. Expect to see more posts right here on SBM explaining why. It turns out that there is almost certainly no "there" there, as we say. That's not to say that psychotherapy and other modalities designed to improve a patient's mood and mental state are not useful. Certainly, they can improve the quality of life of cancer patients when used in the proper situation. However, there just isn't any evidence that is even mildly convincing that such modalities improve a patient's chances of surviving his cancer or decrease the odds of developing cancer in the first place.

I also know that Lawenda also repeats a favorite alt-med trope ("absence of evidence is not evidence of absence"; i.e., the logical fallacy known as an appeal to ignorance) and claims that "many alternative therapies, once believed by conventional medical practitioners to be merely placebos, have now been shown to have proven therapeutic value (eg, acupuncture, numerous botanical extracts, meditation)." Well, no. Acupuncture has not been convincingly shown to have therapeutic value above that of placebo for any condition. It's also no surprise that botanical extracts might be effective for some things; they are, after all, drugs. Adulterated drugs with lots of impurities whose potency can vary widely from lot to lot, but drugs nonetheless. The appropriation of herbal medicines as "alternative" is in essence the appropriation of the longstanding subspecialty in pharmacology known as pharmacognosy, or the isolation of drugs from natural products. Lawenda even attacks antidepressants based on more recent evidence suggesting that they might not be as effective as previously thought and in some cases might not be better than placebo, an idea ably countered by James Coyne.

In actuality, Lawenda is attacking Dr. Cassileth because she speaks heresy in the world of "integrative" medicine.

Lawenda's rebuke, however, is nothing compared to what comes next. Remember Cassileth's dismissal of the findings of a certain "Yale surgeon" who claimed that support groups improved cancer survival? Next up comes that very Yale surgeon! Yes, indeed. It's Bernie Siegel, and he's not happy. No, he's not happy at all, proclaiming that The Key to Reducing Quackery Lies in Healing Patients and Treating Their Experience. I will admit that Siegel probably has a point when he says that better communication could potentially reduce the incidence of cancer patients turning to quackery, but in making even this reasonable point Siegel overstates his case when he says that quackery would "diminish greatly" if doctors would just learn to communicate better. At this point, I can't help but note that Siegel apparently believes that homeopathy works; so whatever quackery disappeared due to super communications skills of physicians would likely be reborn by those same physicians credulously recommending it. Be that as it may, as we've discussed many times before on SBM, there's a lot more to the appeal of quackery than its being a reaction to doctors who can't communicate. Much of it almost certainly wouldn't even come close to disappearing, even if every doctor turned into a super-empathetic Bernie Siegel clone.

Siegel then dives right in, relying on the sheer force of that awesome empathy of his to rip Cassileth a new one for daring to criticize his work, even if she didn't actually mention him by name:

Our emotions govern our internal chemistry, and hope is therapeutic. We know that laughter enhances survival time in cancer patients, while loneliness has a negative effect. When a Yale graduate student did a study on our support group members and it showed increased survival time for the group’s members, his professor told him that couldn’t be true and made him change the control group so that everything came out equal. Doctors don’t study survival and the power of the mind.

Actually, we know nothing of the sort. Believe it or not, I wish we did know this to be true. Who wouldn't want to be able to increase his or her chances of surviving by finding a way to overcome depression or negative thoughts. There's also more than a little bit of of conspiracy mongering in Siegel's article. In any case doctors and scientists have been studying the "power of the mind" to affect survival for a very long time. What Siegel doesn't like is that in general they haven't found that the mind is nearly as powerful at preventing death as Siegel would like to believe. Cassileth was right; there's a reason for the central dogma of alternative medicine; it's very appealing to believe that sheer force of will or thinking happy thoughts can heal us of serious diseases. Talk about the ultimate form of "empowerment"! Unfortunately, the flip side of that "empowerment" is the implication that if you are not doing well or, if you are a cancer patient and are deteriorating, it must be because you don't have a "positive" enough attitude. Barbara Ehrenreich pointed out the toll this sort of thinking takes on actual cancer patients in her book, Bright Sided: How the Relentless Promotion of Positive Thinking Has Ruined America, even going so far as to entitle a chapter Smile or Die: The Bright Side of Cancer.

Sadly, it doesn't take long for Siegel to go completely off the deep end, stating that the "mind and energy will be therapies of the future," complete with anecdotes about patients supposedly healing themselves of cancer through the mind. Siegel's article is full of alt-med tropes and pure woo. Siegel even recommends The Energy Cure: Unraveling the Mystery of Hands-On Healing by William Bengston, The Biology of Belief: Unleashing the Power of Consciousness, Matter & Miracles by Bruce Lipton, and The Psychobiology of Gene Expression by Ernest Rossi. Lipton, as you might know, is a cell biologist who abandoned “conventional” biology after having some sort of mystical revelation about cells that led him to conclude that God must exist and that “holistic” therapies work. I hadn't heard of the other two, but Siegel describes Bengston thusly:

Bengston cured mice of cancer in a controlled study with the energy conducted through his hands. I was healed of an injury in the same way by healer Olga Worral many years ago. We definitely need to test potential therapies to verify whether or not they are useful, but we also have to keep an open mind to what might be possible, and we must understand that we are treating a patient’s experience and not just a disease.

It turns out that Bengston preaches exactly the sort of quackery that Cassileth quite correctly castigated, namely that energy healing can cure cancer! Elsewhere in his article Siegel says he had chronic Lyme disease and was helped by homeopathic remedies. He even says that he "knows they work" because of his "experience of having the symptoms of the disease alleviated." It doesn't get much quackier than energy healing and homeopathy, and Bernie Siegel is promoting them both.

Siegel concludes:

I was a pediatric surgeon and a general surgeon, and I know how powerful my words were to the children—and adults—who believed in me. I had no problem deceiving children into health by labeling vitamin pills as medications to prevent nausea and hair loss, or telling them the alcohol (Drug information on alcohol) sponge would numb their skin (and of course, sharing this with their parents, who helped empower their child’s belief). The mind and attitude are powerful healing forces. The mind and body do communicate, so I work with patients’ dreams and drawings and have diagnosed illnesses from them. I have yet to meet a physician who was told in medical school that Carl Jung correctly diagnosed a brain tumor by interpreting a patient’s dream.

This may not seem related to the subject of quackery, but it is—because it is about how to train doctors so that they know how to provide hope and potential to patients and how to use the mind and placebo effects. Doctors’ “wordswordswords” can become “swordswordswords” and kill or cure patients. I know a man who had cancer and needed cataract surgery so he could enjoy the life that remained to him with restored vision. His health plan denied the surgery because they expected him to die within 6 months and didn’t want to spend the money. He died in a week. The Lockerbie Bomber was released by the Scottish authorities because he was dying of cancer. He went back home to the Middle East and survived for over 3 years— and that is no coincidence.

Note the implication of mind-body dualism ("the mind and body do communicate"), as though the mind were separate from the brain. Now, remember how I discussed some time ago the way the increasing emphasis on placebo medicine among promoters of "integrative medicine," to the point that "thought leaders" in CAM and "integrative medicine" have been furiously rebranding CAM as "harnessing the power of the placebo" in order to produce "powerful mind-body healing," as Ted Kaptchuk frequently does. One can't help but note that even Dr. Cassileth's department offers a variety of mind-body therapies, along with acupuncture and pure nonsense like reiki. As I've said so many times before, the reason integrative medicine fans have taken this position is because they're finally being forced to accept that high quality evidence shows that most alt-med nostrums rebranded as "CAM" or "integrative medicine" produce nonspecific effects no better than placebo. So these nonspecific effects are cleverly relabeled as the "powerful placebo," as proponents of "integrating" quackery into real medicine pivot on the proverbial dime and say that's how their favored therapies worked all along, by firing up placebo effects, which are now rebranded as the manifestation of "mind-body healing"! It also neglects the fact that no placebo has ever been convincingly shown to prolong the life of cancer patients. So much for "mind-body" healing in cancer!

Siegel claims he's "unleashing the healing power" in each of us, but what he is really doing is advocating a return to the paternalistic, unquestioned, shaman-healer so common in so many societies in pre-scientific times. As Kimball Atwood so aptly put it, it's pure paternalism, as well, with a dollop of what I like to call "keeping the customer satisfied." In ancient Egypt, physicians were also priests; both functions were one, which made sense when medicine was so ineffective that praying to the gods for patients to get better was in most cases as good as (or better than) anything ancient physicians could do for them. Also notice how, to Siegel, apparently the end justifies the means. Siegel knowingly deceives patients about vitamins and alcohol sponges because he thinks it's all for a greater good, really believing that he is such an all-powerful a shaman-healer that his words alone can have a huge effect in curing or killing patients. That's how he appears to be justifying the deception. He needs to get a clue (and some humility) and realize that, although placebo effects are important confounders in clinical trials, it's a huge stretch to ascribe such awesome power to their effects. What Siegel is describing is more akin to magic, not science; religion, not medicine. Thinking does not make it so.

Unfortunately, Cassileth doesn't seem to realize that, at their core, the "unconventional" aspects of the "integrative medicine" that she is promoting are little or no different than what Siegel promotes. In essence, "integrative medicine" is all about "integrating" magical thinking into scientific medicine. Acupuncture, "mind-body" interventions, reiki, and all the various quackademic medicine that has infiltrated medical academia relies on the same ideas, the same magical thinking, that we see on display from Bernie Siegel. Cassileth might think herself so much more rational and "evidence-based" by attacking the most egregrious cancer quackery, but she's only fooling herself.

The price of the Central Dogma

As is the case with the central dogma of molecular biology, the central dogma of alternative medicine/CAM/integrative medicine does not cover all cases. For instance, the arguments made for herbalism do not invoke the power of the mind or "mind-body" effects. They are basically claimed to be drugs. True, the claims are usually massively overblown and rely on invocations of "synergy" that are difficult to prove and almost certainly do not exist in the vast majority of cases, but they do not require belief or thought. Nearly all the other major modalities of alt-med do, to greater or lesser extent, depend on the central dogma, particularly if you accept that the the transformation of placebo effects into "powerful mind-body healing" is a consequence of the central dogma.

This central dogma has a price, and that price is paid by both medicine and patients. In terms of medicine, the more we "integrate" various forms of woo (a phenomenon I like to refer to as "quackademic medicine"), the more we integrate the Central Dogma into conventional medicine. It's tempting to repeat Mark Crislip's immortal quip about "integrative medicine" that "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" (oh, wait, I just did). Indeed, through the influence of people like Ted Kaptchuk and Bernie Siegel, among many others, mind-body research institutes and programs are popping up like so much kudzu between the bricks of what should be bastions of academic medicine, places like the University of Rochester, Johns Hopkins University, Washington University, and the University of Maryland, the last of which oversells the potential benefits of "mind-body" medicine, quoting Hippocrates, who said "The natural healing force within each one of us is the greatest force in getting well." Of course, this is prescientific vitalism; so one wonders why an ostensibly science-based university would cite vitalistic beliefs to support the Central Dogma. Whatever the reason, the influx of prescientific vitalism, magical beliefs, and New Age woo disguised as "mind-body medicine" can't help but have a destructive effect on science-based medicine.

It's also harmful to patients as well. Ironically, it's harmful psychologically, the very area where the Central Dogma is supposed to help by producing a fitter, happier, more productive immune system. Perhaps the best discussion I've found about the negative results that flow from accepting the Central Dogma too strongly comes from a sermon by the Rev. Tom Goldsmith of the First Unitarian Church of Salt Lake City, who invokes Ehrenreich's book to make a point:

She [Ehrenreich] begins her book with a chapter on the world she confronted after her diagnosis of breast cancer. I was very moved by her words because it reminded me of one of the more challenging times in my ministry following the 1986 publication of surgeon Bernie Siegel’s Love, Medicine, and Miracles. His thesis was that a vigorous immune system can overcome cancer, and emotional health toward greater self-acceptance helps keep immune systems strong. The underlying message which made my ministry so terribly difficult in that time period stated quite simply that our own inability to govern our emotions with a more positive attitude leads to our own demise with cancer. In other words, we bring cancer on ourselves by allowing immune systems to acquiesce to stress, tension, and negativity in our lives.

I had to deal with enormous guilt among cancer patients who believed they brought on their cancer themselves, and also a suspicion among family members that this could have been avoided altogether if only he or she had better control over his or her emotional life.

After telling the story of an assistant pastor who believed in Bernie Siegel and tried very hard to use positive thinking to cure himself of advanced prostate cancer but still died of his disease believing right to the end that he could heal himself, Rev. Goldsmith points the harm such thinking can cause, recounting how Ehrenreich described feeling a "sense of drowning in all the positive thinking and cheeriness of support groups" and pointing out that her lament was "really about positive thinking distorting reality." And so it was, as is much of "integrative medicine" itself.

No one, least of all I, would argue that positive thinking and wishing for something are necessarily inherently bad things. After all, the path to doing begins with thinking. However, taken as far as someone like Bernie Siegel takes it, the central dogma has a price, and that price is sick people blaming themselves for their disease and, even worse, blaming themselves for not getting better. Sometimes there might be some truth to such beliefs (for instance, when a longtime smoker develops lung cancer), but what is the value of hitting the patient over the head with it? What's done is done, and pretty much every lung cancer patient stops smoking soon after diagnosis. Dwelling on the self-inflicted cause of a disease doesn't help the patient beat it. It promotes unrealistic thinking, magical thinking even, and guilt. This might be justifiable if the case for arguing that the mind could heal the body were as strong as it's claimed, but unfortunately the case for linking emotional health and attitudes with cancer outcomes is very, very weak. Finally, although the "power of positive" thinking might in some cases help a patient improve his quality of life, expecting it to heal serious diseases is expecting too much and "integrating" the central dogma into science-based medicine, more than anything else, contaminates it with magical thinking.

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I have always loved the lament of an committed Communist after the Berlin Wall fell:

The karma ran over my dogma!

We can always hope.

By palindrom (not verified) on 14 Sep 2015 #permalink

Another principle proceeds from the Central Dogma:

thinking makes it so for PARTICULAR people, not for everyone.

Some wishes/ wishers are worthy, others are not.

I often observe amongst the woo-riddled that whenever a tale of healing is told, laudatory adjectives cling to the sufferer/ protagonist like health-amplifying Manuka honey:
he or she dutifully follows orders, always doing as told, never cheating on diets or ( heavens forbid!) questioning the gospel or despairing of one's situation. The woo-meister-in-charge is never doubted but praised to the skies.

Thus, it's the good folk who are rewarded -as in the afterlife- and admitted to the presence of the holy of holies, cured, clean and sanctified.

Currently, I am listening to such a tale unfold at PRN:
( as background, the host has lost several partners-in-crime recently, chief amongst them a doctor-enabler, whose death was blamed upon his unhealthy lifestyle and unwillingness to convert and then, described in gag-inducing detail)
the patient is of African-Caribbean descent and hosted a political show. In the spring, she was diagnosed with "stage 4 cancer" of the ovaries and lung ( probably he woo-meister misunderstands both the concepts of metastases and labels)- but I digress-
she was operated upon and "closed up" - and chemotherapy was advocated by SBM doctors.

HOWEVER she chose the shining path of enlightenment- i.e. veganism, supplements, green juices, faith and exercising against her doctors' advice and that of her brother, who is a physician.

Over the months, she has grown stronger, lost her diagnosis of diabetes and 80 lbs. Supposedly, tests revealed that she has no cancer now: physicians express doubt if she ever had it, to which the quack retorts. "Sue them!"

Thus, she is the ideal patient and applauded as an exemplar for she never doubted the Word nor did she backslide.

Although I wish her well, I wonder what would happen IF she does become ill or die: I venture that she'd then be revealed to be weakened by ( perhaps) pressure from her brother and then, which led to her stopping the protocol or giving up.

You'll notice that when Mike Adams describes a celebrity who has cancer or who has died, it's with barely disguised scorn as though the sufferer is OBVIOUSLY inferior or weak for failing to accept altie nonsense as a treatment plan.
they're shown to be enthralled by SBM's magical incantations and oblivious to the Truth. The same is so at PRN: celebrities are described as egoists, weak-willed or enraptured by SB medicine's lies for rejecting the ministrations offered by the chief idiot.

As the poet wrote:
Oh what a tangled web we weave etc.

By Denice Walter (not verified) on 14 Sep 2015 #permalink

I was wrong on what the dogma is. I would have guessed something like Gnosticism. To say that it is "wishing for healing heals" would mean there is no use for all the sCAM treatments either. A discrepancy I've wondered about for sometime.

Regardless, this is a classic article. I'm am glad you fight for your patients on this front too. I've only recently become familiar with James Coyne's work and it is outstanding. He is currently debunking the science of positive psychology and although he appears to have no interest in how it is being (ab)used in the business world he did answer a request of mine about the blaming the victim part with a tweet that it was something he was thinking of for a blog article.

I could go on about my loathing for the positive thinking movement but I'll endeavor to keep it in check and just say that is remarkable in its unkindness to the sick. I've really not been sick much in my life but I've been around it and what I have noticed, and Denice comment ties into this, is that this thinking is not for benefit of the sick but for those around them. It is a very selfish and unthinking viewpoint.

By Not a Troll (not verified) on 14 Sep 2015 #permalink

@ Not a Troll:

Not all of the denialism is advertisement- some of it functions as a self-protective mechanism in that it enables refusing to acknowledge mortality. If a patient/ family member fails ( dies) BECAUSE he or she didn't live correctly OBVIOUSLY, the woo-meister will never be in the same position because he ( and it usually is a 'he') would never eat incorrectly, miss taking handfuls of supplements, have negative thoughts or suchlike, denying reality. Interesting, the woman described previously has now participated in athletic events and won a race. Although this is a common meme- people win foot races in Florida all the time with stage 4 cancer, MS and other ills.

No, I'm not making that up.

By Denice Walter (not verified) on 14 Sep 2015 #permalink

Denice,

I wasn't thinking of the advertisements of the woo power brokers; I was thinking of a person's peers but you raised a good point anyway. As far as the athletic event, having walked 25 miles in a day when young and healthy, I can't imagine doing it while not.

By Not a Troll (not verified) on 14 Sep 2015 #permalink

A classic indeed. I've run across this Central Dogma again and again from alt med proponents who make no secret (ahem) of the spiritual foundations of their beliefs. That's really what the term holistic means. It's not about taking all a patient's relevant history into account; it's about including the soul, God, and the Cosmic nature of Mind.

One variation I find particularly annoying is the Course in Miracles assertion that sickness is caused by feeling guilty. As I understand it, you created your own cancer by blaming yourself for things. This way it's the exact opposite of 'blaming the victim.' You have to stop blaming yourself in order to heal. See?

Talk about a mindf*ck.

(1)Sociopaths and others lacking a conscience or a total inability to admit mistakes should therefore be physically healthier , have markedly lower cancer rates, and better cancer outcomes.(2)Dr.Siegel doe not know the difference between anecdote and evidence, as shown in his own claim of isolated instances as general proof.

By DanielWainfleet (not verified) on 14 Sep 2015 #permalink

I would say that the central dogma is even more general; it states
"The universe is a benevolent place and therefore does provide (simple) cures for all illnesses."
This also includes herbal medicine, homeopathy etc.

" This denialism most often takes the form of the 21st century embrace by antivaccinationists and alternative medicine mavens of a hypothesis from the 19th century by Antoine Béchamp that it is the “terrain,” not the microbes, that make us sick."
This is the truth. How do you other wise explain the fragile health of children and the elderly.

"Never mind that in the influenza pandemic of 1918 it was the younger people who tended to die at a higher rate and the pandemic got its start in the U.S. in a military barracks. "

You should read the medical history of Spanish flu. The deaths were due to doctors handing out ASPIRIN. Aspirin was the main reason for deaths of most soldiers.

http://cid.oxfordjournals.org/content/49/9/1405.full

You should read the medical history of Spanish flu. The deaths were due to doctors handing out ASPIRIN

Bollocks. The death toll was just as bad in Samoa, in Greenland, in remote Alaskan communities whether or not aspirin was available.
I appreciate the advice to read the medical history. Also my grandmother would appreciate any advice you might have on egg-sucking.

By herr doktor bimler (not verified) on 16 Sep 2015 #permalink

IKZ, what is the number of patients who took the aspirin doses referenced in the paper?

Even simpler, how many deaths does the author attribute to aspirin?

I'll wait.

" The death toll was just as bad in Samoa, in Greenland, in remote Alaskan communities whether or not aspirin was available."

Where is the connected information?

"Even simpler, how many deaths does the author attribute to aspirin?"

Read the report carefully.

“Even simpler, how many deaths does the author attribute to aspirin?”

Read the report carefully.

I have, IPV, and I can't find any firm numbers on how many deaths were attributed to aspirin.

By Julian Frost (not verified) on 17 Sep 2015 #permalink

The old aspirin influenza canard again? Even if people were overdosed with aspirin a century ago, when they didn't understand the toxicology of salicylates, so what? The age of those dying in 1918 was similar to that seen during the 2009 H1N1 pandemic and we don't treat people with influenza with vast doses of aspirin today.

Also, from Starko's paper:

On 5 October 1918, The Journal of the American Medical Association recommended aspirin: “The acetylsalicylic acid may be given in a dosage of 1 gm. (15 grains) every three hours…or a smaller dose combined with 0.1 gm. (2 grains) acetophenetidin, until symptomatic relief is secured”.

I make that a maximum of 8 grams every 24 hours. However, based on contemporary accounts, Starko claims "daily doses of 8–31.2 grams", based on hourly administration, but she doesn't support this with any evidence and appears to conflate salicin and sodium salicylate with aspirin when both are considerably less toxic than aspirin.

A potentially lethal level of aspirin is greater than 500 mg/kg, requiring a dose in a 70 kg patient in the region of 35 grams. Continued dosing of 8 grams per day might eventually lead to chronic toxicity but, judging by the 2009 pandemic, I agree with this author; the virus alone was quite enough to cause the reported mortality.

Incidentally, when I first started working in clinical biochemistry we would do therapeutic drug monitoring on arthritic patients on high-dose aspirin therapy. IIRC their dose was increased until they developed tinnitus. I would have expected doctors in 1918 to have been able to detect similar signs of overdose and to titrate the dose accordingly, especially since the drug was known to cause deafness in very high doses (Starko mentions this was known in 1913), a side effect that was surely hard to miss.

By Krebiozen (not verified) on 17 Sep 2015 #permalink

Where is the connected information?

I cannot parse this request in any of the languages familiar to me. Please rephrase.

By herr doktor bimler (not verified) on 17 Sep 2015 #permalink

I did read it carefully. Still asking you two questions. Can you answer them, please?

Remember, you wrote You should read the medical history of Spanish flu. The deaths were due to doctors handing out ASPIRIN. Aspirin was the main reason for deaths of most soldiers. and used Starko's paper as your reference. So I'm asking you, again: what is the number of patients who took the aspirin doses referenced in the paper? How many deaths does the author attribute to aspirin?

IKZ,

‘I would have expected doctors in 1918 to have been able to detect similar signs of overdose..”
Does not seem so.

I see nothing there to implicate aspirin and nothing about the symptoms of overdose. Younger people die with that strain of influenza partly because older people are more likely to have acquired immunity to it in previous years and partly because younger people's immune systems are more robust, and more likely to go into a cytokine storm, just as they did in 2009 sans aspirin.

By Krebiozen (not verified) on 18 Sep 2015 #permalink

"India serves as a useful vignette. Mortality in India was staggering, with estimates of 18.5 million persons dead [3] and higher [4]. ........, it is extremely implausible that salicylates played an exacerbating role in anything other than a trivial percentage of Indian mortality."..

This is a wrong example. India was a compromised country.
http://www.elnino.noaa.gov/pandemic_1918_1919.html

If there were doctors and aspirin, the mortality would have been higher. (Most doctors were drafted for army duty in Europe).

Are you always this obtuse? India was in the midst of drought and famine, which certainly played a much larger role with respect to mortality than any putative lack of aspirin or doctors.

First you claim that people were dropping dead because of "doctors handing out aspirin." But wait! Not India! They apparently didn't have doctors and aspirin!

You haven't answered my two questions yet. Still waiting. Futile, right? I should just move on, because you don't have any answers.

This is a wrong example. India was a compromised country.

If there were doctors and aspirin, the mortality would have been higher. (Most doctors were drafted for army duty in Europe).

Mortality already was almost two times higher than in the aspirin-gobbling United States. Though.

And what about Western Samoa? Tahiti? Alaska? And other places with high mortality rates but low access to medical care/medicine?

IKZ,
Here's what I don't get. Maybe some people were overdosed on aspirin at a time when they had no effective treatments for viral infection, though I'm skeptical. We don't give people such high doses any more, and the science of pharmacokinetics is light years ahead of where it was in 1918, so what relevance does it have today?.

By Krebiozen (not verified) on 18 Sep 2015 #permalink

You should read the medical history of Spanish flu. The deaths were due to doctors handing out ASPIRIN.
...
This is a wrong example. India was a compromised country.

So we have gone from "The flu mortality rate was caused by aspirin" to "The flu mortality rate was caused by aspirin, except in any cases where it wasn't". OK.

By herr doktor bimler (not verified) on 18 Sep 2015 #permalink

herr doktor bimler, how's your medical history reading coming along? I'm putting mine off until IKZ answers my questions, or until it's beerthirty, whichever comes first.

Larry Moran at Sandwalk blog would have a fit at the characterisation of Crick's Central Dogma. He has around a post a month pointing out that in the original paper the dogma was written as follows
"The central dogma of molecular biology deals with the detailed residue-by-residue transfer of sequential information. It states that such information cannot be transferred back from protein to either protein or nucleic acid"
The idea that DNA->RNA->Protein was termed the Sequence Hypothesis by Crick, not the Central Dogma.

Krebiozen
"I see nothing there to implicate aspirin and nothing about the symptoms of overdose."
You should read the comments of the doctor in context of the analysis of Dr. Starko.

"... Vaughan admitted, “was when I witnessed the hundreds of deaths of the soldiers in the Army camps and did not know what to do."

The doctor would be following the defined protocol that stated use of Aspirin

And, " “If the epidemic continues its mathematical rate of acceleration, civilization could easily disappear from the face of the earth.”

His focus was on soldiers.

Krebiozen
"We don’t give people such high doses any more, and the science of pharmacokinetics is light years ahead of where it was in 1918, so what relevance does it have today?."

Considering the science allows medical world to be light years ahead: what is more important - the terrain or the microbe?

IKZ, citation needed for your remark #26. Who is Vaughan? As for:

Considering the science allows medical world to be light years ahead

What does that even mean?

what is more important – the terrain or the microbe?

Given that infection with Ebola is far more dangerous than infection with Coryza, I'd say the microbe.

By Julian Frost (not verified) on 20 Sep 2015 #permalink

"The basic concept is that the terrain is all, and, of course, you control the “terrain” with your thoughts."

"Long-term follow up of large cohorts of people has upturned most of our predictions about the risk factors and their management. More and more studies throw up various negative attitudes like hatred, depression, anger and jealousy as powerful risk factors for major killer diseases like cancer, stroke, and heart attacks."

Hemingway H and Marmot M. Psychological Factors in the aetiology and prognosis of Coronary Heart Disease. BMJ 1993; 318:1460-67.

"......New Age woo disguised as “mind-body medicine” can’t help but have a destructive effect on science-based medicine."

I will recount an old incident to define the mind body link.
As students, 15 of us had lunch together at a restaurant. We were waiting for the bill when, one friend went into the kitchen and emerged a little later with a dead lizard in his hand to announce that it was found in the curry. All 14 threw up all that we had eaten.

Then, it was taken as a practical joke. Looking at it from the medical view, it explains the control of mind over body.

IKZ, sympathetic vomiting is a known thing.
In addition, I have an anecdote of my own. One Sunday, I had a bottle of beer, a bottle of cider, and one and a half bottles of wine. Despite repeatedly telling myself I felt fine, I wound up vomiting.
w.r.t. terrain of the body, I respond with the story of Graeme Anderson. He was a South African canoeist and a very healthy young man when he was licked by a rabid dog. He developed rabies and despite undergoing the Milwaukee Protocol, he died.
Great health may up your chances of survival, but it doesn't guarantee it.

By Julian Frost (not verified) on 21 Sep 2015 #permalink

Tony,

Larry Moran at Sandwalk blog would have a fit at the characterisation of Crick’s Central Dogma.

I recently read that Crick later admitted he didn't know what 'dogma' meant:

"My mind was, that a dogma was an idea for which there was no reasonable evidence. You see?!" And Crick gave a roar of delight. "I just didn't know what dogma meant. And I could just as well have called it the 'Central Hypothesis,' or — you know. Which is what I meant to say. Dogma was just a catch phrase."

By Krebiozen (not verified) on 21 Sep 2015 #permalink

IKZ,

“I see nothing there to implicate aspirin and nothing about the symptoms of overdose.”
You should read the comments of the doctor in context of the analysis of Dr. Starko.
“… Vaughan admitted, “was when I witnessed the hundreds of deaths of the soldiers in the Army camps and did not know what to do.”
The doctor would be following the defined protocol that stated use of Aspirin

So what? As I pointed out earlier, the same mortality was observed in the 2009 H1N1 outbreak without aspirin's effects. The virus (and cytokine storm) itself is an adequate explanation. I see no reason to think Starko is correct, and even if she is, you still haven't answered my question: what relevance does a mistake made nearly a century ago have to modern medicine?

And, ” “If the epidemic continues its mathematical rate of acceleration, civilization could easily disappear from the face of the earth.”

There was no effective treatment for viral infections back then, so it must have been very frightening to see healthy young men succumbing in such numbers - it's a nasty virus!

Considering the science allows medical world to be light years ahead: what is more important – the terrain or the microbe?

Oh. I see. You do know that Bechamp recanted his theories about terrain on his deathbed? [Well, it's just as true as the story of Pasteur recanting.]

Anyway, both are important: if your immune system is impaired you may be vulnerable to more and more severe infections, but there are pathogens, measles for example, that are able to disable the local immune response, so no matter how robust a person's immune system, measles will still infect them if they are exposed and not already immune. Before vaccinations became routine almost everyone contracted measles and other childhood infections, no matter how well-fed and healthy they were.

The bottom line is that, whatever Mike Adams claims, even a perfect best diet and lifestyle will not prevent infection by many pathogens - look at all those healthy Native Americans and Hawaiians who were eating fresh food, drinking unpolluted water, breathing clean air, and getting lots of exercise, yet they were still almost wiped out by European infections when they were first exposed to them.

The best defenses against pathogens we have are hygiene (clean water, sewerage systems, hand washing), vaccines (to prevent infection) and antibiotics (including antivirals) if we do get infected. Good nutrition, exercise etc. are important, of course, but they are not an effective substitute for those defenses, despite the many claims you have seen to the contrary.

By Krebiozen (not verified) on 21 Sep 2015 #permalink

Dammit. Last few paragraphs after 'Oh.' should not be blockquoted.

By Krebiozen (not verified) on 21 Sep 2015 #permalink