quackademic medicine

https://www.youtube.com/watch?v=hopNAI8Pefg

As a science-based physician who has done research, I will also say "fuck you" to Mr. Weeks for his accusation that you have "blood on your hands" along with all the other anti-science and anti-medicine bullshit he spouts in his Huff-Po screed.

Do quacks bleed when a potential source of revenue is squeezed? If true, you'd have to grab them by the purse to have "blood on your hands".

I, too, will join in the fuck youing.

I am not a doctor or a researcher. I did pass my grade school chemistry class. I still am baffled how anyone else who has taken even the most basic class in chemistry can accept homeopathy as a science.

Orac writes,

We’re doctors. Mr. Weeks is not. We save lives. Mr. Weeks does not. I’m a medical researcher. Mr. Weeks is not. I can deal with his unwarranted attacks on us as “antiscience.” I can laugh at them, even. I know we have the data, the science, and reason on our side.

MJD says,

Q. What do Orac and Col. Nathan R. Jessup have in common.

A. They're a few good men.

Mr. Weeks has a lot of nerve accusing anyone of journalistic laziness when he misspells the name of the journalist he's criticizing not once, but twice. Within the same paragraph, no less.

What idiot made him the editor of a journal? Part of an editor's job is to spot and correct errors like that.

While Orac and Chris are rightly irritated by the "blood on their hands" comment, I would point out Weeks only went there because his argument is otherwise so weak as to be nonexistent. He has to resort to hyperbole to get any traction.

Pathetic.

Mr. Weeks has a lot of nerve accusing anyone of journalistic laziness when he misspells the name of the journalist he’s criticizing not once, but twice. Within the same paragraph, no less.

And with two DIFFERENT misspellings, no less. I mean, I know I make a fair number of typos (you try cranking out 2,000 words a day in your spare time and not making typos), but Weeks is a frikkin' EDITOR.

Also, which may be quite telling, is the fact that Mr. Weeks was the AANP's first "Exective Director", and that may fit well with the observations above regarding what I often term a 'reversal of values.'

After all, it is naturopathy by way of the AANP that still quite falsely terms homeopathy a "medicinal science."

So if you like physics and vectors, if "science" is the actual value, what we have in Mr. Weeks is deviation and indistinction:

"-science".

-r.c.

There is a profound difference between Trump and those criticized by Weeks. Pretty much all available evidence demonstrates that Trump is profoundly ignorant about nearly everything. Orac et al actually know things.

I have a suggestion for a title for a regular "column" by Weeks: Weeks Sauce.

Despite his having zero background in scientific research or the design and execution of experiments and clinical trials

More likely, because, not despite. Their publication couldn't survive a pro-science bias.

Here is an open challenge to this Mr. Weeks:

We will inject you with the rabies virus. You have two choices: 1. Follow the science based cure and get the rabies vaccine or 2. Follow the homeopathy/naturopathy cure method(s).

I can bet which choice you will make. Choice 2 leaves you dead, choice 1 will let you live.

I won't say F/U to you because the time and effort with no pleasure wouldn't be worth it. Crawl back into some dark corner and continue to play with yourself. Unfortunately you are proof that the Peter Principle isn't true, you have raised way beyond your competency.

What does Mr. Weeks say about using alternative medicine for cancer? (If he wants to talk about the effects on saving people's lives).

I'd be very surprised if he speaks up against them. I'll try to run a search after teaching.

They’re a few good men.

Yeah, but you think Vinu is a good person, so it's obvious you don't understand the concept.

Johnny
The Bad One

The misspellings and lack of eighth-grade-level copy editing should have consigned this little rant to the round file. I stopped reading HuffPo years ago when it lost its editorial direction, but this kind of sloppiness is inexcusable in something that still has such a large audience. I'm almost as disappointed that the mainstream press is providing cover for his ridiculous false-balance argument. Who reads his journal? Is it indexed anywhere? Who's paying for it? A supplement manufacturer? A woo peddler? Is anyone asking those questions? There are hundreds/thousands of garbage/front journals. Why give a garbage journal editor any voice at all?

To give Weeks credit, "anti-integrative medicine vigilante" is a bit more creative than "polarization-based medicine bloggers", a term he used in the course of this outpouring of verbal diarrhea:

https://www.integrativepractitioner.com/whats-new/all-news/april-2015-j…

I suspect part of his angst stems from Orac's lack of respect for NDs (Weeks is married to one).

Climate-change denialist? Wait till he calls you a holocaust denialist.

What idiot made him the editor of a journal? Part of an editor’s job is to spot and correct errors like that.

That's not the job of an EIC. I have no idea whether the new SnuffPo has putative comma jockeys (PLOS doesn't), but even copyeditors need copyediting. On the other hand, the misspellings could be deliberate.

. . . On the other hand, the misspellings could be deliberate.

And therefore juvenile, at best.

@ Johnny (#12),

No, I think Vinu is a "great" person based on creativity and effort.

You (Johnny) are also a "great" person based on creativity and effort.

Therefore, you have fallen off the top100 list of Orac's minions:

98) helpmeplease
99) Willtodie
100) David Corcos
101) Johnny

After twenty years of steering clear of the subject, Weeks struggles mightily to keep both buttocks on the middle of the fence when considering "the most sacred of cows in U.S. medicine".
https://www.integrativepractitioner.com/whats-new/all-news/furies-vacci…

Pusillanimous ignorant creep.

@doug #8: LOL. I broke Rule #1.

@Narad: It actually is the EIC's job, the buck stops with him. But I'll grant you, the role has become much more ceremonial than it used to be, which probably explains the declining quality of print publications in general nowadays.

MJD: no one is fooled by your pathetic attempts to suck up.

In other news: Tom Price has resigned...

No loss. Though, at this rate the Orange Cheeto will have to replace his entire cabinet, and he hasn't even been in office a full year yet.

The bonus is, Price is out of Congress for at least a couple of years.

You round-earth fanatics are so polarising with your refusal to even consider the flat-earth evidence. What is wrong with an integrative approach that combines the complementary aspects of both cosmologies?

MJD,

Therefore, you have fallen off the top100 list of Orac’s minions

You actually keep tabs of Orac's minion?!?!

@ herr doktor bimler (#24),

You Schwarzbier fanatics are so polarising with your refusal to consider Dunkel.

Friday night cheers, cosmological friend!

Alain (#25) asks,

You actually keep tabs of Orac’s minion?!?!

MJD says,

I certainly do, the list has grown considerably over the last seven years.

You (Alain) have moved up on the list (#97) due to Johnny's Orac-less disposition lately.

Congratulations Alain!

Pgp, don't be too hard on MJD. His posts help me keep "obsequious" on the tip of my tongue - with "simpering", 'sappy' and other s-words slightly astern. Alas "exsanguinated sequoia" images intrude into my imagination. Irritating.
Don't let his lame litter lead to lament - Rubus replies recommended.

I have a quarter-inch diameter canker sore on my uvula.

In misery, please recommend a science-based treatment.

I've tried hydrogen peroxide and chloraseptic (1.4% phenol) but continue to suffer.

Please advise...

Orac, this article reads as if it were a guest posting by your and our esteemed 'friend', Dr Gorski, rather than by our revered blinky-light box.

So, I did some googling. Weeks is basically self taught, no degree, somehow worked his way to editing an alternative health journal, runs an alternative health blog, and is married to a naturopath? How did he get to the "forefront of encouraging the “integration” of quackery with real medicine?"

This is one of my problems with the alternative health industry - what Dr Offit calls the "false prophets."

UCI, which is my alma mater, will lend respectability to alt health with this donation, Weeks is right. That is a real shame. I wish there was some way for them to turn this down and stick to good science.

What do the Samuelis have that wins such devoted defenders? $200 million to give away! That's all you need to know.

I’ll grant you, the role has become much more ceremonial than it used to be, which probably explains the declining quality of print publications in general nowadays

EICs haven't been proofreaders in nearly half a century. Please don't try to teach your grandmother how to suck eggs.

It's not only $200-million. It's a visionary $200-million investment!
And you can same the same visionary investment in ludicrous high-tech precision medicine. When quackery triumphs, it means that there is no hope for the patient.

sorry, you should read;
you can MAKE the same

For the Washington Post, or JAMA, I'll agree with that.

For small, serious journals with small budgets, nope. The EIC is still involved in the process.

Believe me, I learned this the hard way when I published in a small journal earlier this year. They still managed to leave in errors I told them to correct after I reviewed the galley proofs.

I'm afraid that I do have to agree with Weeks on one thing. Ant-Science screeds should never get the coverage in the media that they do. False balance has done more to harm science education and policy in North America than just about anything else. But if a policy to ban that was put into effect, Weeks would be ranting about censorship.

I really wish our anti-hate laws could be used to keep the NDs from advertising in Dr COS-play dress in Ontario. It does serve to remind me why I don't watch broadcast television.

@28 Doug: You forgot moronic and imbecilic, both highly appropriate when referring to MJD.

Anonymous Pseudonym (#35) writes,

You forgot moronic and imbecilic, both highly appropriate when referring to MJD.

MJD says,

I found some relief from the canker sore on my uvula (comment #29) and it comes from an article in Reader's Digest.

https://www.rd.com/health/wellness/stop-canker-sore-pain/

I thought about going to the doctor but a Google search presented an article with a multiplicity of natural remedies described above in the Reader's Digest article.

I saved a lot of $ by avoiding the doctor and continue to be thankful, in some situations, that there are alternatives to science-based medicine.

Big thanks to Google and artificial intelligence.

Schwartzbier is #FAKEBIER created by liberals.

Schwartzbier is #FAKEBIER created by liberals.

It's no Apex Predator, but I'll take a $4.99 four-pack of Köstritzer happily.

Believe me, I learned this the hard way when I published in a small journal earlier this year. They still managed to leave in errors I told them to correct after I reviewed the galley proofs.

And this demonstrates that the EIC is also the Comma Jockey in Chief how, exactly?

Orac IS an "anti-integrative medicine vigilante", a badge methinks he wears with pride. So what Orac doesn't get into is how much division and contention there is within the rubric of IM. Weeks isn't just an IM propagandist. He's a propagandist for the worst sorts of IM. He's not out to legitimate what Orac calls "quackademic medicine". TPTB there (places like Mayo) don't need him, and probably don't want him either. He's out to legitimate IM as a specialty practiced by autonomous individual providers – in essence re-branding the neighborhood naturo-quack. This is far different from and vastly more expansive than what the "quackademic" programs do – a good number of which limit the CAM to a few 'modalities' employed for pain management and supportive therapy (in which placebos are actually useful), and all that I know of have any CAM providers working under and limited by qualified MDs.

This is NOT what Weeks wants. Or should I say it's not what the grifters he shills for want. He makes his living by representing alt-med companies and interest groups. And for this cabal, IM isn't about helping folks get through chemo or distracting them from musculo-skeletal pain rather than dosing them with opiods. No, it's all about "prevention"! or IOW supplement scams. Weeks being in bed with firms like XYMOGEN which pile a variety of shady business practices on top of manufacturing dubious products to begin with.

I don't buy that he's genuinely outraged and offended by Orac's critique of UCI on principle. His attempt to run a Turdblossom on 'anti-science' is transparently calculated and cynical. My bet is he's trying to use the controversy Orac and Novella have generated for his own agenda and/or his clients' agendas. Maybe he's trying to ingratiate himself with an institution that now has $200 million to spend. Maybe he hopes to pull the new UCI program into an even quackier direction. Maybe he just wants to use the prestige of the UC system to promote legitimacy for his own brand of IM, as if they were the same thing. Which they're not, no matter that Orac may find both unacceptable...

There are two editors for the journal. Both have equal responsibility for all aspects of publication. It's a really small, new journal that publishes once a year. My article came out in Issue 2.

Yes, it's peer reviewed. No, it's not a predatory journal (it's sponsored by my university). But the editors actually have to edit.

Hey, MJD, here’s a poem for your next book -
*Not safe for work*
https://youtu.be/HhGuXCuDb1U

And try as I like, a small crack appears in my diplomacy-dike.
"By definition", I begin,
"Alternative Medicine", I continue,
"Has either not been proved to work, or been proved not to work.
Do you know what they call 'alternative medicine' that's been proved to work?
Medicine."

@Johnny (#44),

When science-based medicine fails, hope is clearly derailed.
When 'alternative medicine' fails, a hope silently prevails.
When all else fails, there is no hope.

The canker sore on my uvula is waning (comment #38), I'm hopeful that the use of natural remedies made a difference.

@ 42 Panacea

But the editors actually have to edit.

Clearly your business model needs some fine tuning.

http://deevybee.blogspot.ca/2017/07/breaking-ice-with-buxom-grapefruits…

I believe the poem MJD provided is by the acclaimed British poet Paula Nancy Millstone Jennings of 37 Wasp Villas, Greenbridge, Essex, GB10 1LL.

@ Johnny (#47),

Allow me to add a condescending enhancement with respectfully-insolent intent:

When science-based medicine fails, hope is clearly derailed.
When ‘alternative medicine’ fails, a hope silently prevails.
When all else fails, there is no hope you DOPE.

Paula N. M. Jennings can't take credit for that, Johnny. :-)

@jrkrideau: I guess I'm having an Aspie moment. I'm not sure what you mean to say with your link.

@49 Panacea

Editors are supposed to charge "page fees" not read the paper!

Title of paper:
[b]Breaking the ice with buxom grapefruits: Pratiques de publication and predatory publishing [/b]

In this case, it does not appear that anyone even read the title. And in this case the "editor" did not even get the cash.

Oh, silly me!

Heaven forfend there actually be any editing.

When science-based medicine fails, hope is clearly derailed.

Something something Jesse Fuller something.

Johnny:Snicker. It's hilarious to me that neither MJD or NWO read books, despite both of them being older than me. Well, supposedly in NWO's case, as I'm not convinced they aren't actually a twelve-year-old.

David Brin, who I find always worth reading even when I don't agree with him (https://davidbrin.blogspot.com/) speaks of there being a war against the fact-using professions, and I think this is just another example of that.
I can't describe it as well as he does, so go read him.

I'm trying to picture the respectable Dr. Gorski and Dr. Novella bumping chests and shouting. I think that would be a perfect way to commemorate next years 10 yr NECSS anniversary! :)

Kat -- D'you think they could get Dr Lance O'Sullivan teach them how to do a haka? That would be awesome.

https://www.youtube.com/watch?v=W235oVNy2bs

May I suggest The rock if Dr O'Su,llivan is not available?

[youtube https://www.youtube.com/watch?v=l7E3Sph45z8?rel=0&w=560&h=315]

Which one gets to wear the pink, Gorski or Novella?

Integrative medicine is trying to hitch a ride on the coattails of actual medicine. I'm reminded of a con artist who wants credit for mixing an occasional truth in with his lies.

MJD,

May I suggest a hydrochloric acid throat gargle. That should get rid of your canker together with your entire uvula, tongue, throat, and the ability to speak. A marked improvement you'd have to agree.

Billyjoe: Careful there. MJD's dumb enough to actually do that.

Actually, since simple canker sores typically heal by themselves in about a week,
https://www.webmd.com/oral-health/guide/canker-sores#1

it's quite likely that any alternative treatment MJD uses will "work".

Acids are not recommended, though.

It's been five days, so how is your sore doing, Michael?

Have you visited your dentist? I'll probably need to see mine soon myself.

You know what you are? You are an anti-integrative medicine careerist and a big pharma shill.

Yawn:
http://scienceblogs.com/insolence/2013/02/14/the-pharma-shill-gambit/

Homeopathy at UC-Irvine: The administration can run but it can't hide from its history of embracing quackery

oracknows — Tue, 26 Sep 2017 04:01:40 +0000

Homeopathy at UC-Irvine: The administration can run but it can't hide from its history of embracing quackery

Last week, the University of California, Irvine (UCI) announced that Susan and Henry Samueli were donating $200 million for it to set up a massive new integrative medicine initiative. The plan would basically transform biomedical sciences and medical education at UCI—and not in a good way.

Remember what "integrative medicine" is. What is being "integrated" into medicine is, of course, quackery. Oh, sure, integrative medicine also emphasizes lifestyle modification, such as diet and exercise, but that is part of "conventional medicine" already.

There is no good scientific or medical rationale for a separate specialty devoted to just that. What integrative medicine does is that it rebrands perfectly science-based modalities, such as diet and exercise, as somehow "alternative" and then "integrates" quackery, like naturopathy, acupuncture, functional medicine, applied kinesiology, homeopathy, and basically any form of quackery you can think of. Without the quackery, there is no integrative medicine.

Worse, the phenomenon has resulted in a most pernicious effect in medical academia, the infiltration of outright quackery into the research and education efforts there, a phenomenon I like to refer to as "quackademic medicine."

Of course, The Very Serious Academics In Very Serious White Coats who have come to believe in integrative medicine to the point of devoting their careers to it would vehemently disagree with my characterization. I'm referring to the sort of doctors who present at conferences of learned academics and write what they claim to be evidence-based care guidelines for breast cancer patients. Perhaps the best thing to mention to rile up serious academic advocates of integrative medicine is homeopathy. Any mention of homeopathy is guaranteed provoke paroxysms of self-righteous denial.

"Oh, no," they'll say, "homeopathy is pseudoscience! It's quackery. Integrative medicine is evidence-based, and we would never do anything that isn't evidence-based!" Sadly, as I've pointed out time and time again, you can't have naturopathy without homeopathy, as homeopathy is an integral part of naturopathy. As long as you have naturopaths, you will have homeopathy. Oddly enough, many of these The Very Serious Academics In Very Serious White Coats are utterly oblivious to this simple fact, even ones who write Very Serious Clinical Guidelines with naturopaths and welcome naturopaths into their Very Serious Medical Society.

ll of this brings me back to UCI, because yesterday there was a story by Michael Hiltzik for the LA Times about this very phenomenon. Well, not exactly. Rather, it's about the relationship between UCI and homeopathy and how UCI seems rather—shall we say?—touchy about the subject:

As of late last week, visitors to the website of UC Irvine Health, that institution’s clinical arm, could learn that among its services to patients was “homeopathy.” That was a problem, because homeopathy is a discredited and thoroughly debunked “alternative medicine.” Even Howard Federoff, UCI’s vice chancellor for health affairs, agreed that the scientific basis for homeopathy was “lacking.” The issue is important because the donors of a $200-million gift to UCI’s medical schools, the billionaire couple Susan and Henry Samueli, are sworn believers in homeopathy and supporters of a raft of other “integrative” health treatments. As I reported, some medical authorities have raised questions about whether the Samuelis’ beliefs and their rare generosity will undermine UCI’s explicit commitment to science-based medicine. So it’s interesting that after I raised questions about the treatment’s listing on the website, it mysteriously disappeared. As of this writing, a UCI spokesman hasn’t gotten back to me with word on when it was removed, or whether its removal means that homeopathy no longer will be offered to patients, or merely that UCI is keeping it quiet. The listing was present as recently as last Wednesday, when I asked Federoff about it in connection with my column about the Samueli gift, which appeared online Friday; its presence can be seen on an archived version of the website dated Sept. 19.

Ah, yes. The light of national attention due to the Samuelis' enormous donation to promote pseudoscience must have rattled UCI. After all, even the most avid proponents of integrative medicine are profoundly uncomfortable with homeopathy, even Dr. David Katz, whose "more fluid concept of evidence" led him to try homeopathy in a patient.

That's because homeopathy is quackery.

Indeed, there's a reason I routinely refer to homeopathy as The One Quackery To Rule Them All. To recap, homeopathy is based on two laws. One states that to treat a symptom you use something that causes that symptom. The other states that a homeopathic remedy becomes stronger with dilution. Neither are based in evidence. Indeed, many homeopathic remedies are 30C or greater in dilution, where C is a 100-fold dilution. Thus 30C means diluting the solution 100-fold thirty times, which results in a dilution of 10^-60.

Given that Avogadro's number is on the order of 6 x 10²³, a 30C dilution is more than 10³⁶-fold greater, which means that it's incredibly unlikely that a single molecule of original remedy remains. Most homeopathic remedies are just water or ethanol diluent. Even the most die-hard advocate of quackademic and integrative medicine has to admit that, which is why even they are so uncomfortable when homeopathy is brought up and so loudly and self-righteously deny that integrative medicine would ever have anything to do with homeopathy.

Amusingly, Hiltzik noted a web page that looked very, very familiar to me, that of Dayna Kowata, ND, LAc. Yes, she's a naturopath and acupuncturist. She also expresses an interest in homeopathy. What's so familiar about Not-a-Dr. Kowata? Well, I used her UCI webpage in talks about quackademic medicine several years ago, and I've even mentioned her on two different occasions on this very blog, albeit not by name. At the time, I didn't know that Susan Samueli is strong believer in homeopathy, but I do now.

I wonder what Ms. Samueli will think if Dr. Federoff actually does eliminate homeopathy from UCI. I rather suspect that she won't be happy. I particularly wonder this based on the original gift agreements between the Samuelis and UCI when the Samuelis first founded the Susan Samueli Center for Integrative Medicine (SSCIM) at UCI. The original gift was $20 million in 1999. Now here's where it gets interesting. In 2003, the board of directors of the Samueli Center was formally founded in the UCI College of Medicine.

You can read the whole thing if you like, but this is the key paragraph:

The proposed Center will build on the considerable knowledge and experience of its faculty to study the efficacy of various therapeutic modalities considered to be part of complementary and alternative medicine, including herbs and homeopathic medicine, as they relate to areas such as cardiovascular, autoimmune and neuromuscular diseases, cancer treatment and prevention; and menopaus and ageing. In addition, the proposed center will foster UCI's emergence as a leader in the area of acupuncture by supporting basic and clinical research into the mechanism of action and the efficacy of acupunctxure as a modality. The proposed Center will encourage and foster multidisciplinary studies that involve appropriate faculty from across the campus as well as from other institutions.

That's right. Homeopathy was baked into the Samueli Center from near the very beginning. I can't help but wonder what would be found in the formal gift agreement for the Samuelis' $200 million donation. Perhaps a Freedom of Information Act request would shed some illumination on this question. On the other hand, I note that homeopathy was only mentioned in one of the gift agreements.

Perhaps then, as now, UCI and the Samuelis learned that homeopathy brought too much embarrassment to the university—and rightly so—and that's why homeopathy hasn't been mentioned in any of the Samuelis' gift agreements since 2003. Alternatively, most of the gift agreements after that had to do with setting up fellowships and endowed chairs and gave UCI administration the latitude to use the gifts for whatever purposes it judged most consistent with the wishes of the donors.

Contrary to what Dr. Federoff claims, quackery is deeply embedded at UCI. It's the raison d'être for the SSCIM. He might be in denial about it, but it's true. That's why I was amused to read Hiltzik's observation:

The on-again-off-again appearance of homeopathy on UCI’s website and among its clinical offerings underscores the difficulties the university may face in navigating the inconsistencies between the world view of its biggest donors and its explicit commitment to rigorous scientific standards in its medical teaching, research, and clinical treatment. The Samuelis, after all, will have their names on UCI’s main on-campus medical building, and their gift will endow up to 15 faculty members, all of whom will have to demonstrate some “expertise in integrative health.” We reported over the weekend that “integrative health” is interpreted by many in the medical profession as code for introducing unproven and debunked nostrums into a curriculum that should be based exclusively on scientific evidence. Although Federoff says science will govern at UCI, that hasn’t necessarily been the case at the Susan Samieli Center, which was established in 2001 with a $5.7-million donation from the couple and will be converted into the Susan Samueli Integrative Health Institute and absorbed into the university’s entire medical complex under the terms of the gift.

I can't help but note that Dr. Federoff came to UCI from Georgetown University. Why is that significant? Georgetown was one of the "pioneers" (if you will) in quackademic medicine. Basically, Georgetown was the first to "integrate" quackery into all phases of medical education beginning in the first year of medical school, with acupuncturists giving lectures in gross anatomy class. I kid you not.

By the time Dr. Federoff left Georgetown in 2015, quackademia reigned supreme at Georgetown, even to the point where Georgetown credulously teaches homeopathy to its medical students. Dr. Federoff was there when it began and took hold. You'll pardon me if I call bullshit on his claims that the SSCIM will be rigorously based in science. It won't. That's not what the donors want, and that's not what the culture at UCI will support.

Thanks to the Samuelis and the credulous culture they have built at UCI and fueled by the enormous $200 million gift given by the Samuelis, quackademic medicine will reign more supreme than ever at UCI and serve as an example for the metastasis of the cancer that is integrative medicine.

oracknows Tue, 09/26/2017 - 00:01

Tags

University of California Irvine

Categories

http://www.webmd.com/balance/tc/homeopathy-topic-overview

I wonder what she will think if Dr. Federoff actually does eliminate homeopathy from UCI.

He's just diluting the curriculum to make it more effective.

I always find it stunning that someone can have a very scientific mind and have invented/patented multiple devices of incredible complexity and then turn around and buy into something as ridiculously stupid as homeopathy. But smart in one area never means smart in all areas.

"smart in one area never means smart in all areas."

Just can't leave Ben Carson alone, huh?

Wait, they're going to use homeopathy to treat heart disease, cancer and autoimmune diseases? That's what they're saying?

Chris Hickie (#2) writes

But smart in one area never means smart in all areas.

MJD says,

But, being creative (i.e., invented/patented) in one area often means creative in other areas.

It appears Henry Samueli is simply being creative with his $ based on the love and affection he has for his wife.

Remember the Taj Mahal?

It was commissioned in 1632 by the Mughal emperor, Shah Jahan (reigned 1628–1658), to house the tomb of his favourite wife, Mumtaz Mahal.

The Taj Mahal didn't change world architecture and, in parallel, UCI's $200 million from Mr. Samueli will not change science-based medicine.

@ Orac,

Stop whining and let it play out.

MJD: The Taj Mahal didn’t change world architecture.

Oh man, every time I think you can't be more wrong, you prove me wrong. Obviously, you've never been to Southeast Asia. Or seen a Russian orthodox church. Or Aladdin.

"UCI’s $200 million from Mr. Samueli will not change science-based medicine."

That's about as ridiculous as saying that Russia has no influence in the US. Do you know where doctors come from? Medical schools. If one medical school is teaching inaccurate and just plain bad medicine, the practice will spread to other medical schools and hospitals. California already has a huge problem with quacks and people who abandoned their medical degrees (see "Dr" Gordon and "Dr" Sears.) So no, Orac can't just let this one 'play out.'

PGP writes,

So no, Orac can’t just let this one ‘play out.’

MJD says,

If Orac wants to confront Dr. Gordon and Dr. Sears that's fair.

But, the billionaire couple Susan and Henry Samueli are NOT medical professionals and can most definitely be appreciated for their charitable contributions to UCI.

@ Orac,

If UCI made a disclaimer that homeopathy is intended to be researched as a supplementary-treatment would you back off?

In the spirit of freedom-of-choice, homeopathic medicine may have a theatrical placebo effect that may improve the quality-of-life for some individuals dealing with science-based medicine.

I wonder if UCI will apply homeopathy methods for teaching their med students. Think how fast you can turn out docs if you dilute each course by 30c. I think they may need to start with a blood sample from a real doctor before they begin their dilutions.

I can just see the RonCo knock-off: Become a MD for only 49.95 but wait if you order right now get the second one for only process and handling.

Wandering in from my respite...

PGP: " Every time I think that you can't be more wrong, you prove me wrong"

Agreed.

Srsly, MJD telling Orac to "stop whining" truly illustrates self unawareness at its most ironic
.
It's like Mike Adams bemoaning the current state of education
or AoA's Managing Editor discussing poor writing or Jake Crosby investigating anything

MJD: But, the billionaire couple Susan and Henry Samueli are NOT medical professionals and can most definitely be appreciated for their charitable contributions to UCI. "

Nope. Still wrong. If they'd donated a no-strings attached gift to UC Irvine, that'd have been fine and no one would find fault with them. Unfortunately their "gift" came with more strings attached than you'd find on the entire Muppet cast of Sesame Street.

What a ridiculous article. Everything is prejudged and makes mockery of basic human knowledge. Pharna lobby seeing a danger to its business is out in the open.

@Ash

Oh, to be blissfuly clothed in the raiments of ignorance.

"If UCI made a disclaimer that homeopathy is intended to be researched as a supplementary-treatment would you back off?"

I hope not - nobody should, since the fact that homeopathy is discredited means there is no evidence that it benefits anyone except the quacks who practice it and pocket the checks. People who understand science and reality understand that. Given your history of comments it's no surprise that you don't understand it.

Ash: "Everything is prejudged and makes mockery of basic human knowledge."

What basic human knowledge? A couple of big pharmaceutical companies are Boiron and Hylands. You may have actually bought some of their special little pills in the tiny bottles. So to save from the tyranny of supporting Big Homeopath Pharm, I present you this way to make your own:

Recipe for Nat Mur or Natrum Mur or Natrium Mur or Natrum muriaticum:

1) Take ½ teaspoon of sea salt and dissolve into 1 cup of distilled water in a bottle.

2) Shake well.

3) This is a 1C solution (ratio 1/100).

4) Take ½ teaspoon of the 1C solution and put it a bottle with 1 cup of distilled water, throw out the 1C solution.

5) Shake well.

6) This is a 2C solution (ratio 1/10000).

7) Take ½ teaspoon of the 2C solution and put it a bottle with 1 cup of distilled water, throw out the 2C solution.

8) Shake well.

9) This is a 3C solution (ratio 1/1000000).

10) Take ½ teaspoon of the 3C solution and put it a bottle with 1 cup of distilled water, throw out the 3C solution.

11) Shake well.

12) This is a 4C solution (ratio 1/100000000).

13) Take ½ teaspoon of the 4C solution and put it a bottle with 1 cup of distilled water, throw out the 4C solution.

14) Shake well.

15) This is a 5C solution (ratio 1/10000000000).

16) Take ½ teaspoon of the 5C solution and put it a bottle with 1 cup of distilled water, throw out the 5C solution.

17) Shake well.

18) This is a 6C solution (ratio 1/1000000000000).

19) Take ½ teaspoon of the 6C solution and put it a bottle with 1 cup of distilled water, throw out the 6C solution.

20) Shake well.

21) This is a 7C solution (ratio 1/100000000000000).

22) Take ½ teaspoon of the 7C solution and put it a bottle with 1 cup of distilled water, throw out the 7C solution.

23) Shake well.

24) This is an 8C solution (ratio 1/10000000000000000).

25) Take ½ teaspoon of the 8C solution and put it a bottle with 1 cup of distilled water, throw out the 8C solution.

26) Shake well.

27) This is a 9C solution (ratio 1/1000000000000000000).

28) Take ½ teaspoon of the 9C solution and put it a bottle with 1 cup of distilled water, throw out the 9C solution.

29) Shake well.

30) This is a 10C solution (ratio 1/100000000000000000000).

31) Take ½ teaspoon of the 10C solution and put it a bottle with 1 cup of distilled water, throw out the 10C solution.

32) Shake well.

33) This is a 11C solution (ratio 1/10000000000000000000000).

34) Take ½ teaspoon of the 11C solution and put it a bottle with 1 cup of distilled water, throw out the 11C solution.

35) Shake well.

36) This is a 12C solution (ratio 1/1000000000000000000000000).

37) Take ½ teaspoon of the 12C solution and put it a bottle with 1 cup of distilled water, throw out the 12C solution.

38) Shake well.

39) This is a 13C solution (ratio 1/100000000000000000000000000).

40) Take ½ teaspoon of the 13C solution and put it a bottle with 1 cup of distilled water, throw out the 13C solution.

41) Shake well.

42) This is a 14C solution (ratio 1/10000000000000000000000000000).

43) Take ½ teaspoon of the 14C solution and put it a bottle with 1 cup of distilled water, throw out the 14C solution.

44) Shake well.

45) This is a 15C solution (ratio 1/1000000000000000000000000000000).

46) Take ½ teaspoon of the 15C solution and put it a bottle with 1 cup of distilled water, throw out the 15C solution.

47) Shake well.

48) This is a 16C solution (ratio 1/100000000000000000000000000000000).

49) Take ½ teaspoon of the 16C solution and put it a bottle with 1 cup of distilled water, throw out the 16C solution.

50) Shake well.

51) This is a 17C solution (ratio 1/10000000000000000000000000000000000).

52) Take ½ teaspoon of the 17C solution and put it a bottle with 1 cup of distilled water, throw out the 17C solution.

53) Shake well.

54) This is an 18C solution (ratio 1/1000000000000000000000000000000000000).

55) Take ½ teaspoon of the 18C solution and put it a bottle with 1 cup of distilled water, throw out the 18C solution.

56) Shake well.

57) This is a 19C solution (ratio 1/100000000000000000000000000000000000000).

58) Take ½ teaspoon of the 19C solution and put it a bottle with 1 cup of distilled water, throw out the 19C solution.

59) Shake well.

60) This is a 20C solution (ratio 1/10000000000000000000000000000000000000000).

61) Take ½ teaspoon of the 20C solution and put it a bottle with 1 cup of distilled water, throw out the 20C solution.

62) Shake well.

63) This is a 21C solution (ratio 1 in 10^42 or 1/1000000000000000000000000000000000000000000).

64) Take ½ teaspoon of the 21C solution and put it a bottle with 1 cup of distilled water, throw out the 21C solution.

65) Shake well.

66) This is a 22C solution (ratio 1 in 10^44 or 1/100000000000000000000000000000000000000000000).

67) Take ½ teaspoon of the 22C solution and put it a bottle with 1 cup of distilled water, throw out the 22C solution.

68) Shake well.

69) This is a 23C solution (ratio 1 in 10^46 or 1/10000000000000000000000000000000000000000000000).

70) Take ½ teaspoon of the 23C solution and put it a bottle with 1 cup of distilled water, throw out the 23C solution.

71) Shake well.

72) This is a 24C solution (ratio 1 in 10^48 or 1/1000000000000000000000000000000000000000000000000).

73) Take ½ teaspoon of the 24C solution and put it a bottle with 1 cup of distilled water, throw out the 24C solution.

74) Shake well.

75) This is a 25C solution (ratio 1 in 10^50 or 1/100000000000000000000000000000000000000000000000000).

76) Take ½ teaspoon of the 25C solution and put it a bottle with 1 cup of distilled water, throw out the 25C solution.

77) Shake well.

78) This is a 26C solution (ratio 1 in 10^52 or 1/10000000000000000000000000000000000000000000000000000).

79) Take ½ teaspoon of the 26C solution and put it a bottle with 1 cup of distilled water, throw out the 26C solution.

80) Shake well.

81) This is a 27C solution (ratio 1 in 10^54 or 1/1000000000000000000000000000000000000000000000000000000).
(the zeros are running off of the page!)

82) Take ½ teaspoon of the 27C solution and put it a bottle with 1 cup of distilled water, throw out the 27C solution.

83) Shake well.

84) This is a 28C solution (ratio 1 in 10^56 or 1/100000000000000000000000000000000000000000000000000000000).

85) Take ½ teaspoon of the 28C solution and put it a bottle with 1 cup of distilled water, throw out the 28C solution.

86) Shake well.

87) This is a 29C solution (ratio 1 in 10^58 or 1/10000000000000000000000000000000000000000000000000000000000).

88) Take ½ teaspoon of the 29C solution and put it a bottle with 1 cup of distilled water, throw out the 29C solution.

89) Shake well.

90) This is a 30C solution (ratio 1 in 10^60 or 1/1000000000000000000000000000000000000000000000000000000000000).

And then you are done! To make the pills, go to baking center of your grocery store and get some plain cake decorating sprinkles. You can try dropping some of the solution on the sprinkles, or just set the bottle next to the solution for it to absorb the energy (which is the typical method used for over the counter homeopathic remedies).

dean (#13) writes,

Given your history of comments it’s no surprise that you don’t understand it.

MJD says,

It is written, "Homeopathy is based on the idea that "like cures like." That is, if a substance causes a symptom in a healthy person, giving the person a very small amount of the same substance may cure the illness. In theory, a homeopathic dose enhances the body's normal healing and self-regulatory processes.

Q. Doesn't allergy shot immunotherapy, which is science-based, falls within the parameters of homeotherapy.

Example, low dose of a natural allergen with repeated exposure to decrease sensitivity to that allergen.

https://www.aaaai.org/conditions-and-treatments/treatments/allergy-shots-(immunotherapy)

In this instance, conventional medicine and integrative medicine overlap.

I don't know how much experience anyone here has with college/university development offices, but those folks are usually glad-handing snakes. Their job is to get as much money from donors first, and then see that the fewest strings are attached to it so the school administrators can use it any damn way they please. In this, they are expert are snowing both the faculty and the donors. They have lots of tricks for this – making it look to the donor like the money will go to one thing when it actually goes to something else, and then forcing the faculty into continuing the ruse through the years...

Which is not to say that $200 million doesn't buy a lot of influence. Just that how much influence and where it lands is a complex negotiation, and PR releases can't be trusted to give a proper indication of how it all will play out. My guess would be that most of the The Susan and Henry Samueli College of Health Sciences will be giving only lip service to IM, and continuing the re-branding of useful stuff they were already doing as "integrative". That is, very little of the $200 million will be going to 'quackery'. But, on the other hand, the old Susan Samueli Center for Integrative Medicine is being upgraded and more firmly anchored institutionally within UCI along with the renaming to the Susan Samueli Integrative Health Institute.

Another way to put it: $200 million buys getting your name on a school, but it's probably not enough to dictate everything that goes on inside, (or even all that much of it...). Academic institutions much smaller than the UCI med school are as easy to turn around as the Titanic, and declarations of 'new cutting edge program!!' are more often than not puffed up with hype while most day-to-day business stays pretty much the same.

That's my experience anyway in my corner of academia, which I admit is far away from health sciences, but it seems pretty common, fwiw. Of course, things could be different at Irvine ("Zot! Zot!"), but of all the news I'll read this week, this is likely to worry me the least.

Spectator @12: Oh, that is brilliant. May I borrow it when the need arises?

#15 Michael J. Dochniak, September 26, 2017

MJD says,
It is written, “Homeopathy is based on the idea that “like cures like.” That is, if a substance causes a symptom in a healthy person, giving the person a very small amount none of the same substance may cure the illness.

FTFY.

Q. Doesn’t allergy shot immunotherapy, which is science-based, falls within the parameters of homeotherapy.
Example, low dose of a natural allergen with repeated exposure to decrease sensitivity to that allergen.

The difference is that the low dose is a low but non-zero dose; where the homœopathetic dose is diluent only, a dose of zero.

The other fallacy of your simile is that the extremely low dose of active ingredient in the anti-allergy treatment is designed to produce a subtle effect, teaching the patient's immune system that the allergen really ain't anything to be askeered of. That's why the dose is small rather than non-zero.

OTOH, the homœopathetic "dose", with no remaining active ingredient, is claimed to produce a profound effect, curing whatever the symptom might be.

The similarity you imagine vanishes upon examination.

What is this zot thing everyone keeps going on about?

PGP, you should look up UC-Irvine's mascot for the answer.

Sadmar: I think you're underestimating the influence donors can have on a school.

Why go to the Susan and Henry Samueli College of Health Sciences when you can be taken for a more enjoyable ride at nearby Disneyland?

Despite the classic Hahnman infinite dilutions theme, historical connection or popular association with herbal, natural or nutritional treatments exists with (some?) homeopathic doctors.

So I'm unclear what percentage of lay persons saying that they want homeopathic treatment are really buying into the infinitely dilute treatments superstition.

Go Eaters! Zot!

Quackademic medicine now reigns supreme at UC-Irvine

oracknows — Tue, 19 Sep 2017 04:55:38 +0000

Quackademic medicine now reigns supreme at UC-Irvine

It's not infrequently that, whenever I complain about the increasing infiltration of quackery and pseudoscience into medicine, I sometimes lament that skeptics and supporters of science-based medicine are massively outgunned, because we are. Thus, we have the continued growth of what I like to refer to as "quackademic medicine," the infiltration of pseudoscience into medical academia in the form of whole divisions, departments, and institutes dedicated to studying fairy dust like acupuncture, naturopathy, and other "unconventional" treatments that are then "integrated" into medicine. It's not for nothing that I refer to "integrative medicine" as integrating quackery with medicine.

Unfortunately, I was reminded yesterday of what an uphill battle it is to counter the increasing pseudoscience in medicine when I learned that wealthy donors Susan and Henry Samueli just donated a whole bunch of money to the University of California, Irvine (UCI) to establish an institute dedicated to pseudoscience:

The University of California, Irvine today announced the largest gift in its history: $200 million from Susan and Henry Samueli, longtime campus supporters, to name a first-of-its-kind College of Health Sciences focused on interdisciplinary integrative health. The far-reaching donation – the seventh-largest to a single public university – positions UCI as a bold, new leader in population health, patient care, education and research. “This gift catalyzes UCI’s belief that human health and well-being requires a science-based approach that engages all disciplines in caring for the whole person and total community,” said Chancellor Howard Gillman. “Susan and Henry Samueli’s dedication, their vision for what is possible and their deep generosity will help UCI set a standard that, over time, other medical centers in the U.S. can follow.”

Thanks to the Samuelis, unfortunately UCI has long been a prominent force in the brave new world of integrative medicine. Now, it appears to be taking this "integration" a step further, by "integrating" the pseudoscience across not just the new institute. Behold:

The Susan and Henry Samueli College of Health Sciences will be the first university-based health sciences enterprise to incorporate integrative health research, teaching and patient care across its schools and programs. Integrative health redefines the relationship between the practitioner and patient by focusing on the whole person and the whole community. It is informed by scientific evidence and makes use of all appropriate preventatives, therapeutic and lifestyle approaches, and healthcare professionals and disciplines to promote optimal health and wellness. The existing Susan Samueli Center for Integrative Medicine will become the Susan Samueli Integrative Health Institute and will focus on improving medical care by supporting multidisciplinary research, education, clinical service and community programs. Faculty and students in computer science, engineering, social sciences, business and other areas will collaborate within the institute to study the future of human health.

Of course, the whole paragraph about integrative health "redefining" the relationship between the practitioner and patient by focusing on the "whole person" is the usual blather that quacks everywhere. As I've said so many times before, it is not necessary to "integrate" pseudoscience into medicine in order to take care of the "whole patient." A good science-based primary care doctor takes care of the "whole patient," with no need to resort to appealing to magic like acupuncture, reiki, reflexology, homeopathy, and the like. And if you don't think this is about all of the forms of quackery I just mentioned, take a look at how the Samuelis became interested in "integrative" medicine:

Susan Samueli caught a cold while visiting France more than three decades ago. Instead of the usual medicines, a friend suggested aconite, a homeopathic remedy derived from a plant in the buttercup family. She was cured — and became a lifelong advocate of homeopathy and other alternative healing methods to complement conventional medicine. Her husband, Henry — the billionaire co-founder of Broadcom, the Irvine semiconductor maker — says he was initially skeptical but found the integrative health approach helped him easily shake off colds and flus and kept their children healthy without antibiotics. Now the couple’s passion for integrative health has led to the largest donation ever made to UC Irvine.

As an origin myth, This is just downright silly. Colds are self-limited, and the homeopathic remedy Mrs. Samueli took almost certainly had no effect on the course of her cold. She just got better, as the vast majority of otherwise healthy adults with colds do. As for Mr. Samueli's apparent belief that homeopathy and other "integrative" approaches helped him shake off colds and flus, the same thing is going on. Colds are self-limited. So is the flu for most people, although what most people call the "flu" isn't really the flu but much milder "flu-like illnesses" caused by other viruses. (The real flu can easily knock you on your posterior for a week or even more.)

Basically, this story is a load of confirmation bias and good old-fashioned regression to the mean being confused with therapeutic effect. Yet, that's all it takes for otherwise intelligent people to become believers. Humans are pattern-forming animals. If we take something and then get better we'll say that what we took caused us to get better, whether it really did or not.

Of course, supporters of "integrative medicine" will no doubt become indignant at my description of their favored new medical specialty. They will point to how diet and exercise are an important part of integrative medicine, how integrative practitioners emphasize prevention and healthy lifestyle. The problem, of course, is that diet, exercise, healthy lifestyles, and prevention are all part of conventional medicine. There is no need for a separate specialty for them, any more than there is a need for a separate specialty in order to take care of the "whole patient."

The reason "integrative medicine" exists is not to promote science-based prevention, lifestyle, and exercise interventions, but rather to provide a vessel into which quackery can be poured and mixed with the science-based care until it becomes difficult to tell which is which. That's the idea, whether physicians who have become integrative medicine practitioners will admit it to themselves (or others) or not. So here's how this next stage of "integration" will go.

The Susan and Henry Samueli College of Health Science will eventually include the existing Samueli Center plus the following schools at UCI:

School of Medicine
Sue & Bill Gross School of Nursing
School of Pharmacy (currently the Department of Pharmaceutical Sciences)
School of Population Health (currently the Program in Public Health)

And here's where the money will go:

The Samuelis’ gift will provide $50 million toward construction of a facility to house the college and $5 million for state-of-the-art technology and labs – forming the foundation of a national showcase for integrative health. It also earmarks $145 million to create an endowment for:

Up to 15 faculty chairs across the medicine, nursing, pharmacy and population health disciplines for senior, midcareer and junior faculty with expertise in integrative health

Integrative health training and mentoring for interested medical school students

Scholarships and fellowships for undergraduate and graduate students planning careers in related fields

Innovative curricular development and campuswide interdisciplinary research projects

Ongoing clinical services, research and education in the Susan Samueli Integrative Health Institute, including investigations of nonconventional interventions as part of medical treatment and educating medical and lay communities about benefits and risks associated with new healthcare approaches

That last bullet point is critical. The whole point of "integrative medicine" is to integrate "nonconventional interventions as part of medical treatment." That means quackery. There is no other reason for integrative medicine. Just think about the evolution of the naming of integrative medicine. First, it was known as alternative medicine. But "alternative" implied that the "nonconventional interventions" weren't medicine (or weren't good medicine, which they weren't).

So the name evolved to "complementary and alternative medicine," or CAM. However, that wasn't good enough either, because the name mean that the quackery was "complementary" to real medicine. It wasn't real medicine itself (or at least it wasn't as effective or important as real medicine). It was just "icing on the cake." So a new name was coined, "integrative medicine," in which all the quackery was (and still is) portrayed as co-equal with conventional medicine and "integrative medicine" as "the best of both worlds." And here we are. A wealthy couple has donated $200 million to a public university to promote their vision of pseudoscience, and the university has eagerly accepted, even though it will utterly reshape its medical school and all its biomedical sciences for decades to come.

I find it helpful to look at what UCI's Samueli Center already offers. I first took note of the school just shy of 10 years ago, when I added the Susan Samueli Center for Integrative Medicine as part of an early version of my Academic Woo Aggregator.Really long time readers of this blog know that for a time I maintained a list of medical schools that had embraced quackademic medicine. I only maintained the list for a relatively brief period of time, not because I didn't think it was a worthwhile endeavor, but rather because there were just too many schools for me to keep track of alone.

Quackademic medicine has become the norm, not an outlier. It's schools like mine, where I'm faculty, that have little or no quackademic medicine that are the outliers. So what does Samueli Center offer? It's basically the same slate of "integrative medicine" that most quackademic "integrative medicine" centers offer:

Acupuncture & traditional Chinese medicine
Ayurvedic therapies
Functional medicine
Massage therapy
Meditation
Mindfulness
Nutritional counseling
Physical medicine & rehabilitation
Preventive cardiology
Sports medicine & osteopathic manipulation
Tai chi
Vitamin infusion therapy
Women's health
Yoga

Of course, traditional Chinese medicine and Ayurvedic medicine are prescientific systems of medicine based on mysticism and vitalism. Functional medicine is a bit of "make it up as you go along" quackery that combines the worst of conventional medicine on steroids (e.g., massive overtesting) with quackery. Vitamin infusion therapy, of course, is also not scientifically supported. As for the rest, Tai Chi and yoga are nothing more than exercise. Massage therapy makes people feel better, but specific therapeutic claims are to be treated with skepticism.

If you want to get an idea of the level of pseudoscience going on here, it's useful to look at what UCI says about various modalities. For instance, "functional medicine" turns out to be all about naturopathy as well:

Functional medicine, which is based on naturopathic principles, takes a more comprehensive approach. At the Susan Samueli Center for Integrative Medicine, our highly trained naturopaths:

Identify and treat the root causes of illness

Harness the healing power of nature

Treat the whole person

Emphasize disease prevention

Encourage self-responsibility for health

Explore alternatives to drugs and surgery

And, based on functional medicine, UCI might offer:

Based on your individual needs, we develop a treatment plan which may include:

Detoxification

Dietary and lifestyle changes

Exercise therapy

Herbs and dietary supplements

Homeopathy

Manipulative therapies

Psychotherapy and counseling

Stress reduction

There you go. "Detoxification" is virtually always the purest of quackery. Then, of course, there's homeopathy, or, as I like to call it, The One Quackery To Rule Them All. If you don't know why that's the case, I refer you to any of a number of my previous posts, like this one. Of course, one aspect of "integrative medicine" is bias. Basically, its adherents don't ask whether it will help patients and result in better outcomes. Rather, they confidently predict that they will be vindicated in their beliefs:

“As a preventive cardiologist and researcher, I cannot stress enough the critical need for society to adopt a truly integrative approach to health, whether we are talking about community health, nutrition, prevention or appropriate medications. It must start with those who provide care and guidance,” said Dr. Shaista Malik, director of the Susan Samueli Center for Integrative Medicine and the endowed chair of integrative medicine. “Through this exciting new college, we will demonstrate to everyone involved in the health system – from patients to providers to policymakers – the value of an integrative approach.”

And:

Fundamental change in thinking about healthcare and how it’s delivered will take time, a steady stream of new evidence and strong academic leadership. The Samuelis’ transformational gift is the first step toward creating an expanded health sciences campus, integrating the affiliated schools and programs of the college as well as new teaching, research and clinical spaces. “Susan and I have supported healthcare research for nearly 20 years, and over that time, we have seen a significant expansion of the scientific evidence demonstrating the value and efficacy of integrative health. This evidence base is critical as UCI – a young, innovative institution – takes this big and influential step,” said Henry Samueli, Ph.D., an engineer and co-founder of Broadcom Corporation. “We are very excited for the UCI College of Health Sciences to become a national model for integrative health. We believe this model will eventually become the standard approach for promoting health and well-being in our society.”

That's right. Adherents of "integrative" medicine "believe" that it will eventually become standard of care. What evidence do they base this belief on? Certainly not on evidence. I do note that advocates of integrative medicine are quite honest about their goals, as you can see from this article in the the LA Times:

The Samuelis said they hope their financial support for research will help build evidence for alternative therapies that would convince insurers to pay for them, thus letting more people benefit. Acupuncture, for instance, has been widely documented to ease migraines, according to Howard Federoff, a specialist in neurodegenerative disorders and UC Irvine’s vice chancellor for health affairs. But not all health plans cover the treatment.

No, acupuncture is nothing more than a theatrical placebo. When I say that skeptics and supporters of science-based medicine are at a profound disadvantage, this development at UCI is exactly what I'm talking about. What we have is a ragtag band of physicians and skeptics alarmed at the infiltration of pseudoscience into medicine versus very wealthy believers like the Samuelis willing to donate far more money than we can imagine.

Sure, we have science on our side, but will it matter? We have to make it matter.

oracknows Tue, 09/19/2017 - 00:55

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https://www.forbes.com/sites/williampbarrett/2016/12/14/the-largest-u-s…

"Quackademic Medicine now reigns supreme at UC-Irvine"

But aren't you an "Assistant Professor" in Michigan?

Oh, Travis, you're several years behind the times. I was promoted to full professor last year and had been an associate professor for several years before that. You must be reading J.B. Handley.

I would like to think there are faculty at the UC Irvine School of Medicine who are upset about this--because if there are not then things are much worse than feared. Why do these faculty not speak out against this pseudoscience? Some of them must be tenured, which should grant the ability to speak openly on such nonsense. Then again when I was doing my residency at the University of Arizona, I never saw anyone openly oppose Andre Weil and his nonsense, which has openly infiltrated many of the residency training programs there since I finished my training.

Shruggies. The vast majority of physicians are shruggies. https://sciencebasedmedicine.org/a-shruggie-awakening/

In a Forbes article titled, "The Largest U.S. Charities for 2016" a quick calculation indicates ~ 7 billion dollars donated to medical organizations that are predominantly science-based.

I'm thankful for their generosity...

It has to be said that to some extent, physicians have nurtured this entire movement--not because they don’t care or are ignorant of what constitutes a healthy lifestyle, but because the truth of these thing just isn’t what people want to hear. I am as guilty of this as anyone else. When I ask my doc about some diet-related thing and she gives me a half page blurry handout on her way out the door, I am grossly offended, but because I know that there is no magic, I accept it. Had she been a naturopath, the interaction would have gone very differently and if I weren’t so steeped in skepticism, I would tend to be much happier with the naturopath, even more so if I were not a skeptic.

It is one thing to acknowledge that “there are problems in medicine” but it is time to offer some real solutions to them instead of bemoaning the success of the quacks in addressing people’s need to interact with their health provider on a more personal level. And don’t say there’s no time because I’ve had providers who achieve a level of care that addresses “the whole person” in the same amount of time that most utterly fail. I accept a level of care that falls short of better experiences because I am an informed skeptic, but most people aren’t and that’s why they respond so well to the woo.

We have done well at outlining the problem, but very little to address it on our own side. My favorite example is that my PCP, a lovely woman who has been my doctor for seven years, has not ONCE asked me how I am--something the dietician (my fave provider) always does. If I bring up mental health (just everyday type of mental health, not serious impairment), she stiffens, mumbles about a psychiatrist or a psychologist (ack!) if I “just need to talk”. This is not an isolated example; I have been through a number of providers at this medical center and it’s all pretty much the same. I’m currently seeking a smaller institution, but that is difficult in my state. My friends find various integrative quacks instead. I used to argue, but I’ve become somewhat of a shruggie these days, given my own state of dissatisfaction with the system. Mind you, I’m not seriously ill or anything, but isn’t that the demographic that is so ripe for the picking by the quacks?

Don’t misunderstand my horror at the goings-on at UCI, but we have to do more than bemoan it. If diet and exercise are “part of medicine”, more needs to be done to make regular people aware of that. Saying “30 minutes a day” or “25 grams a day” and a handout with stick people for back pain are not enough, even though that may be the actual truth of things.

I’m sorry if this comment relies too heavily on personal experience, but I use it to amplify interactions that I have on an almost daily basis over many years. Although I am educated, I don’t travel in academic circles anymore, and as you all know, that is no guarantee anyway that one will not encounter woo--hence today’s sad tale of UCI.

Clearly you need a new primary care doctor. No, I'm serious. The one you have clearly isn't meeting your needs. I haven't had that problem with my last two PCPs; so I'll counter your anecdote with mine.

A bit off topic, please.

I noticed that someone (maybe Mike Adams?) has changed the referenced image in comment #70 of Orac's post titled, "Does the Flu Vaccine cause miscarriages?"

Orac and Mike Adams are matter and antimatter, I appreciate both!

Chris@3: Never mind the faculty, what do the accreditation people think of this? From where I sit, it looks as though UCI is in thrall to a couple of big dollar donors who are encouraging the medical faculty to practice a form of medicine that the donors themselves, let alone the faculty, either know or should know does not work.

I can understand the reluctance of soft money faculty to speak up. They may be dependent on the university for things like bridge funding and lab space, and are therefore not as free to speak their minds as faculty should be. But the accreditation board is designed to be independent of a university's donors. They have no excuse for not pushing back at the first opportunity.

I am a PCP, and have been for 25 years (damn, that is hard to type!) What I have found is that in order to counter this movement you need to be familiar enough with the woo to discuss it with some knowledge. If your patent asks your opinion on massage or chiropractic and you roll your eyes and tell them they are idiots, the interaction will not go well. It does require time spent reading sites that reek of stupid so you know of what they speak, but if you can build a relationship, it is possible to counteract a lot of this. The major drawback is that it takes time, both in reading and talking, and most of us are very pressed for time. Nonetheless, I have a fairly huge antivax population and have been successful at getting the majority of them to get at least some shots. Is that a win? I think so. The latest is everyone needs lip and tongue ties lasered. (!) No clue where this came from, but with research I have talked several down from that ledge. It's all about knowing your patient and your stuff.

"$5 million for state-of-the-art technology and labs" State of what art? And of course they need labs to conduct imaginary tests to produce imaginary results that require imaginary interventions to treat imaginary symptoms, no doubt.

Looking into the accreditation process and registering complaints is a good idea. Also, mingling state and federal funds with these donations should be investigated as well. Contacting your California congress member about your taxes going to support this kind of nonsense if you live in California is a good place to start.

The fact that some science based medicine practitioners are not communicative is not the fault of science based medicine, it is the fault of those practitioners, but yes, we do need to be more proactive towards people that pursue peudo-medical solutions. It won't make you any friends, though. A friend of mine has a little local paid ad service and he regularly allows ads from other friends who advertise the whole spectrum of pseudo-medicine, but he won't allow me to run ads that debunk pseudo-medicine, citing the controversy that would result for him. I think it is mainly because, he too, is a believer. He suggested a juice fasting book to me and said I just didn't want to face the unpleasantness of fasting when I told him it was bull$hit. He's right to an extent, I really don't want to face the unpleasantness of starving myself by consuming just vegetable juice for one or two weeks, especially since it has no positive effects on one's body other than dramatic although temporary weight loss.

@ Eric #9: good point. I have wondered this as well. I suspect the accreditation folk look more at a school meeting the requirements of what they want taught and turn a blind eye to the rest . I don't know if there's a "things you can't teach and get accreditation list" out there, but there ought to be.

What really upsets me is that as the pseudoscience gets embedded over time, the physicians being graduated--unless they have a solid background in science prior to medical school--are going to take all this pseudoscience at the same level of truth as their lectures on anatomy, physiology and pathophysiology. That is not good. Not good at all.

"Is this the shape of medicine to come?"

Can it get much worse than mainstream medical quackery?

Bioinformatics analysis links type 1 diabetes to vaccines contaminated with animal proteins and autoreactive T cells express skin homing receptors consistent with injected vaccines as causal agent
https://www.researchgate.net/publication/319592904_Bioinformatics_analy…

Oddly enough, I just saw an ad here at RI for "relaxation, meditation" as tools in " your arsenal" and clicked it in order to see which woo-fraught institution was advertising its wares and lo! and behold! it was
the AIRFORCE. trying to get health care professionals.

Because I live in an area with money ( mostly) I notice how much regular doctors ( MDs. DOs) as well as DCs advertise all the usual woo ( acupuncture etc) as well as newer ( possibly SB) options like
lasers.
Is this just a way to make potential clients feel that their so-called individual needs will be addressed or a way to earn more?

Heh. Vinu cites an article he wrote himself, that contains references to articles he wrote him self, that contains references to articles he wrote himself, that contains references to articles he wrote himself... and there I grew tired of the exercise, but it's Vinu all the way down.

When you cite your own work more than all other people cite your work, I would think professional help may be indicated.

Funny - the only person he ever cites is himself.....

Oh, come on, Johnny. How is Vinu supposed to gain any credibility unless he's referenced in other articles? So by referencing himself in more articles he's written and then repeating it ad nauseum , the impact factor on his articles goes WAY up...or at least rises above zero.

@Vinu: when no reputable person (outside of yourself, for all I know you are reputable in other parts of your life) references your writings, maybe you should take a look at the reason.

MJD: " In a Forbes article titled, “The Largest U.S. Charities for 2016” a quick calculation indicates ~ 7 billion dollars donated to medical organizations that are predominantly science-based."

And? Why do you care about this? You don't even care about science.

the whole person, the whole person, the whole person... magic, wishful thinking, wooly bullshit... the whole person, the whole person.. blah de bah.. behhhe, sheep noise, behhhe.. gobble, gobble.. grovel, grovel.. GI'Z THE BLOODY MONEY!!!

Is this just a way to make potential clients feel that their so-called individual needs will be addressed or a way to earn more?

These options are not mutually exclusive. It's probably both: a floor topping and a dessert wax.

@ #14 Denice Walter.

I suspect it is both revenue enhancement and virtue signalling of some sort. I first encountered the "revenue enhancement" term in connection to use of certain devices and procedures related to some surgeries I was checking on. The links were to sites directed to hospitals and physicians. Sort of chips away at one's faith in the profession.

PGP (#17) writes,

And? Why do you care about this? You don’t even care about science.

MJD says,

I knew you'd be the first minion to initiate a conversation with a personal question. :-)

For the record, I care about science.

For example, I think vinu arumugham (#13) is a creative and well-respected vaccine-safety-advocate who is science-based.

A bit off-topic but of great concern because of the misleading post above about $7 billion going to science-based medical organizations.

Who says they are science-based? You? The 501 (c) 3 structure for charities in the US is highly porous and has almost no meaningful oversight. I suspect there are many, many fake charities and science-y-sounding front groups set up by supplement manufacturers and vitamin/quackery hustlers who have figured out either how to get phony IRS charity status or qualify for it under even more porous state charity laws as a tax dodge for their profits.

The house organ publications and "research" entities I've seen at some of these quackpot web sites strongly suggest they are gaming the system in some very sophisticated ways to evade financial oversight and confuse the gullible about their wonderfully magnanimous efforts to advance public health and conduct legitimate research--all the way to the bank.

"She was cured — and became a lifelong advocate of homeopathy and other alternative healing methods to complement conventional medicine. Her husband, Henry — the billionaire co-founder of Broadcom, the Irvine semiconductor maker — says he was initially skeptical but found the integrative health approach helped him easily shake off colds and flus and kept their children healthy without antibiotics."

As emphasised, Mrs S was not 'cured' of anything by homeopathy - and neither were their children spared 'antibiotics', which of course have no effect on viruses.

Surely it shouldn't be possible for a billionaire to influence the progress of medicine in the US in this way? Surely he would be laughed out of the consulting room? Whatever next? A billionaire with bizarre ideas as President? Surely not.

Lots of acupuncturist were put in jail before Dr Lok Yee Kung in 1973. It was so unfair . It was an unhill battle fought in Nevada. Finally Dr Lok Yee Kung and his supporters won the decisiive battle. Since than Acupunctuirist recognized. Many states soon follow to open up and recognized Acupuncturists as health professionals. Lots of evidence shows Acupuncture works and it is matter. The patients became their own judge.

"Oh, Travis, you’re several years behind the times."

Wrong again, duck.

Then again, it's not really at all surprising.

"Oh, Travis, you’re several years behind the times."

Wrong again, duck.

Then again, it's not really at all surprising...

"Oh, Travis, you’re several years behind the times"

Wrong person yet again, oh duck. It's really not surprising; not in the least bit.

It must so terrible being such a paranoid quack.

Heads up for Orac: Check the spam filter, and tell other ScienceBloggers to do the same. The disappearing post issue is back.

For the record, I care about science.

For example, I think vinu arumugham (#13) is a creative and well-respected vaccine-safety-advocate who is science-based.

MJD,

That would be your own version of science.

This inquiring mind here want to know how your version of science is in accordance with:

1-: Scientists' definition of science?

2-: Philosophers of science definition of science?

Alain

"Interdisciplinary" in this context also really rubs me wrong. Which disciplines are being combined?

And what will happen if the research shows these other methods don't work?

Perhaps MJD has a point, and I may have been a bit harsh in my response to Vinu.

Vinu was complaining about medical quackery, and, unlike many commenters, offered up a prime example of quackery. He pointed us to a quack paper, written by a quack, full of quack ideas.

I appreciate when people provide examples, references, and citations, and wish to encourage such behavior.

I do disagree, however, that Vinu is 'science based', and believe that MJD's endorsement of those ideas proves PGP's point quite nicely.

I like when universities accept money to promote blatant quackery, otherwise people are unable to judge how corrupt they are.

MJD: "For the record, I care about science.
For example, I think vinu arumugham (#13) is a creative and well-respected vaccine-safety-advocate who is science-based."

How can you not see how contradictory those sentences are? As others have pointed out, Vinu's got nothing. His so-called research is pulled, whole cloth, out of his rear end. So are your 'theories.' You wouldn't know science or writing skills if they BIT you.

I, too, laughed out loud when I read MJD's comment.

Thank you for writing on this. Any ideas on getting my university held accountable for such nonsense?
https://ufhealth.org/integrative-medicine/integrative-medicine-consulta…
http://smallanimal.vethospital.ufl.edu/clinical-services/integrative-me…

PGP (#24) says,

Vinu’s got nothing.

MJD says,

Mathematics was stagnant before the initial conceptualization of zero (e.g., nothing) was discovered.

Therefore, nothing can lead into something amazing.

Keep up the outstanding work Vinu (#13).

What a long article to say UCI got a lot of money and I'm jealous. The Samuelis can do whatever they want with their money

Listen and become one of Orac's minions.

https://www.youtube.com/watch?v=8HqyEHqEYho

The only time mjd seems to care about science is when he needs to look its spelling up in the dictionary. The rest of the time he doesn't think about it.

Mathematics was stagnant before the initial conceptualization of zero (e.g., nothing) was discovered.

Well no, it wasn't. Apparently you are as ignorant of mathematics as you are science. I'd say you should take some of my classes but I wouldn't be able to tolerate your dishonesty.

Obviously, homeopathy is a bunch of bs. However, in the "origin myth" she talks about taking homeopathic aconite for a cold, and mentions that it's related to buttercup. Buttercups are pretty, right? What she took (suggesting there were theoretically any molecules of it in the preparation to begin with) is wolf's bane. It's also known as the queen of poisons. I will never understand how these people can be terrified of vaccine adjudivants, but will willingly take poison.

Mathematics was stagnant before the initial conceptualization of zero (e.g., nothing) was discovered.

Well no, it wasn't. Apparently your denial of science extends to unfamiliarity of mathematics.

MJD,

Zero in math does not equal nothing. Zero is a discreet point on a number line. Because a number line is infinitely long any point maybe considered the zero point.

When we get to real life yes, zero has taken on the meaning of nothing in a material sense.

Not to mention that the ancient Egyptians, who had a concept of zero, would beg to differ. They left us the pyramids as proof.

MJD: Unsurprisingly, you know about as much about math as you do everything else. I hope you didn't pay for that 'education.'

I just want to know what this purported "stagnation" is supposed to comprise. Coordinates are enough of a nuisance as it is.

Therefore, nothing can lead into something amazing.

Um, no.

Add or subtract nothing to something, you don't get anything more or anything less - you aren't lead anywhere.
Start with nothing, multiply or divide it by something, and you lose everything. Despite popular belief, deux fois rien ('twice nothing') is still nothing.
Take something, pull it up to the power of nothing, and you go back to step one.
In the rare case when you start with nothing and put it to the power of nothing, you end up staring at oneself. It's a bit navel-gazing.
Have something, divide it by nothing, and now you are contemplating not infinity, but insanity.
And despite your best wishes, it doesn't get better when nothing is applied to imaginary numbers.

Throughout history the rich have patronized their favorites causes. Sometimes society wins like when Carnegie funded libraries. Unfortunately it can also lead to legitimization of quackery such as this.

Mathematics was stagnant before the initial conceptualization of zero (e.g., nothing) was discovered.

Well no, as others have pointed out, that is not at all true. But I'm not sure whether you mean the concept of zero as (roughly) "no amount" or its use as a place holder for large number. Symbols in cuneiform exist in numerals that play the same role as 0 in our numerals like 640002.

Either way, it's clear you don't have any understanding of the issue, which is consistent with your lack of understanding of science and the related statistical issues. I'd suggest you should study to catch up, but you've shown no interest in learning anything, so that won't work.

And if you subtract something from nothing, you are now either in debt or in the basement.

Perhaps MJD should review Billy Preston's research on the subject.

https://youtu.be/G_DV54ddNHE

I agree more with #6 darwinslapdog. A lot of this reflects MSM failures, often hubristic and massively profitable. Failures to achieve, retain, extend, parse out, or at least accurately explain in many areas, often old. You guys don't even have the vitamin C and D stories remotely correct.

However manifold the faults of various integrative practices, it is the ongoing failures of medicine that largely have brought this about. Perhaps analogous to "those who fail to learn history are doomed to repeat it".

The cynical parts of me certainly worry about the medical versions of Willie Sutton going where the money is, as well as MSM exploitation of charlatans to establish even more repressive Medical Authority and exploitation of the public, again.

Wow, with PRN here, we've got almost the full cadre of armchair, rear-based scientists. I wonder if NWO or Thingy want to chime in.

oh good lord, that is my alma mater. Some anteaters died at this news. Zot. Sigh. I am appalled. Just appalled.

I have to add that this does not surprise me about Orange Co California. There is are a reason Bob Sears has his practice there and that is pretty much antivax central. A lot of OCers are completely ignorant of science and rational thinking. I grew up there. I moved north for a reason!

Turf wars!!! Science have been killing off people for a few decades now. LMFAO. How do you justify that? Moron!!

I misspoke. Evidently we were missing a Fendlesworth chimp.

Kathy: I thought the creators of BC were hard-core rightwingers and allergic to facts.

Have any academic medical centers cashed in yet on health woo for members of the armed forces? Big bucks await those who can take battlefield acupuncture to the next level.

https://www.facebook.com/photo.php?fbid=1433197313382128&set=p.14331973…

dean (#42) writes,

Apparently your denial of science extends to unfamiliarity of mathematics.

MJD says,

Maybe you can add this to your teachings.

https://www.livescience.com/27853-who-invented-zero.html

Provide a brief summary of this article dean and I'll grade it with total objectivity.

Emergency acupuncture! (2017 edition)

oracknows — Tue, 20 Jun 2017 05:53:53 +0000

Emergency acupuncture! (2017 edition)

If there's one form of quackery that is among the most "respected," it has to be acupuncture. I've often speculated about why this might be, and the best that I can come up with is that doctors are a bit more open to acupuncture because it involves sticking actual needles into the body. It's very easy to ignore the mystical, vitalistic BS about "redirecting the flow of qi" because doctors can easily handwave and postulate other, more scientific-sounding explanations, such as that it releases endorphins or adenosine. If that doesn't work, then acupuncturists add electricity and thereby rebrand transcutaneous electrical nerve stimulation (TENS) as "electroacupuncture." At the risk of being too anecdotal, a decade or two ago I was more open to acupuncture for this very reason. I never accepted idea that sticking needles into specific points somehow redirected the flow of a mystical, magical "life energy," but I could imagine that somehow sticking needles into the skin might "do something." What, I wasn't sure, but something. Of course, over the years, the more acupuncture studies and literature I read, the more I realized just how little "there" was there and how acupuncture is no more than a theatrical placebo.

One thing that I've always had a hard time understanding about acupuncture advocates is their desire to represent acupuncture as a useful treatment modality for emergency situations. The first time I encountered this sort of thinking was nearly ten years ago, when I first learned of "battlefield acupuncture." Yes, it is exactly what it sounds like, and unfortunately it's becoming more common in the military. Indeed, it was less than three months ago that I described how flight surgeons are being trained in the technique, to be used on wounded soldiers in Afghanistan and wherever US troops are in harm's way. Then there's "emergency acupuncture," which is, as it sounds, the use of acupuncture in the emergency room. I've deconstructed various studies of acupuncture use in the emergency room over the years, and it never ceases to amaze me how any emergency medicine physician could think this was a good idea. Well, here's another one out of Australia by Cohen et al entitled, Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non-inferiority trial.

Before I dig into the study itself, I often like to look at how the study is being reported in the press. The Conversation let the first author of the paper, Marc Cohen, Professor of Health Sciences, RMIT University, to basically pimp his paper's findings under the title Emergency doctors are using acupuncture to treat pain, now here’s the evidence. It's basically a recounting of the study itself, touting it as the "largest of its kind in the world," as though size guaranteed scientific rigor. First, he notes:

Using acupuncture to relieve pain involves placing needles in various parts of the body to stimulate the release of endorphins and other neurochemicals, which can act as the body’s naturally occurring pain relievers.

For generations various cultures around the world have used acupuncture to treat multiple conditions, including providing pain relief. And in Australia, it is reimbursed through the Medicare Benefits Schedule when administered by a medical doctor.

Of course, this is just the usual nonsense acupuncture apologists routinely lay down as a justification for their theatrical placebo. It's basically handwaving and impressive, sciencey-sounding babble. He does, however, provide a succinct explanation of what an "equivalence" or "non-inferiority" study is:

Our trial was an “equivalence” study, which means we aimed to see if the different treatments were equivalent rather than seeing if they were better than placebo. We did this as it would not be ethical to give a placebo to people coming to an emergency department for pain relief.

This is, of course, a reasonable enough rationale to run a non-inferiority study. It's the reason most such studies are run, because, for whatever reason (usually ethical), a placebo control arm can't be used. I also note that this is a pragmatic trial as well. The idea is to show that the novel treatment is not inferior to existing standard-of-care treatments. What is usually done is to decide upon a non-inferiority margin, which is basically how much different by whatever scale measured than control an effect has to be before it is considered clinically inferior. It's also reasonable to do a randomized controlled clinical trial using a design appropriate for a non-inferiority trial. Those are the pluses of the trial, such as they are. And, yes, it's a decent-sized trial, although by no means really large. Indeed, that this is being touted as the largest such trial of its kind in the world rather speaks poorly of the state of acupuncture research. In any case, the study involved 1,964 patients who were assessed between January 2010 and December 2011, resulting in the randomization of 528 patients with acute low back pain (270 patients), migraine (92) or ankle sprain (166) were randomised to acupuncture alone (177 patients), acupuncture plus pharmacotherapy (178) or pharmacotherapy alone (173). (1,112 patients did not meet inclusion criteria, and 324 declined to participate.) The study itself was carried out at four different tertiary hospitals in Melbourne, Australia. Finally, the primary outcome measure assessed was pain at one hour (called T1 in the study). Clinically relevant pain relief was defined as achieving a pain score on a 10-point verbal numerical rating scale (VNRS) below 4, and statistically relevant pain relief as a reduction in VNRS score of greater than 2 units.

The interventions themselves included:

Acupuncture alone. Acupuncture was provided by either a registered Chinese medicine practitioner or an ED physician with medical acupuncture qualifications. Treatment protocols (online Appendix), determined by a panel of specialist acupuncturists, provided predetermined points for each condition, as well as additional points for individualising treatment.

Pharmacotherapy alone. Pharmacotherapy was administered according to a standardised protocol based on the relevant national guidelines of the National Institute of Clinical Studies and the National Health and Medical Research Council. This protocol included first and second line drugs, as well as rescue medication administered at the discretion of the treating physicians, regardless of group allocation.

Combined treatment. Combined therapy included both acupuncture and pharmacotherapy, with acupuncture administered 15 minutes before or after pharmacotherapy to maintain blinding of the acupuncturist.

You can see the pragmatic trial design. The acupuncturists could individualize treatment within limits, and pharmacotherapy could also be personalized within the context of Australian national guidelines for the pharmacotherapy of pain. Here I consider it important to mention that I've discussed the use of pragmatic trials in acupuncture more times than I can remember. There is one requirement for a pragmatic trial, and it's a requirement for a non-inferiority trial as well. That requirement is that the novel modality being tested against standard-of-care must already have been demonstrated to work in randomized clinical trials. As much as acupuncturists like to try to claim that acupuncture has been shown to work for the various health issues for which it is used, in reality when you look closely it's not hard to see that the studies are most consistent with acupuncture "working" through placebo effects, not through any specific physiologic effect. As I like to say when discussing acupuncture studies, doing pragmatic studies on acupuncture is putting the cart before the horse. The same is true of non-inferiority studies. Show that acupuncture works in randomized clinical trials first, and then do the pragmatic or non-inferiority trials, if applicable.

So back to this study. There's another aspect to the design of the study that should make you immediately question its results. Before I get to that, I'll tell you the results. Quite predictably the trial showed noninferiority. Basically, acupuncture was not detectably inferior in short turn pain relief in any of the conditions tested. Depressingly, overall, only 16% of patients had clinically relevant pain relief and 36.9% statistically relevant pain relief at T1. That's a rather low number. Then there was no statistically significant differences between the three groups. Now what would you think if I were to tell you that this was only a single-blind study. Neither the patients nor the practitioners were blinded to experimental group. Those who assessed pain scors were blinded, and so were the statisticians who carried out the analysis. Thus, the potential for placebo effects was maximized.

There's also another little tidbit buried in the results that no one seems to be reporting on, and that's the use of rescue analgesics. "Rescue" therapy is additional therapy given at the discretion of the treating physician after the primary therapy, usually because there hasn't been sufficient improvement. In the case of this study:

The acupuncture only group received significantly more rescue medication therapy than the groups that received pharmacotherapy(at T1: p=0.016; after T1: p=0.008; Box 6). Oral opiate medication was offered as first line rescue medication to patients in the acupuncture group and parenteral opiates to the two pharmacotherapy groups.

Basically, the acupuncture-only group was nearly twice as likely to require rescue opioids as pharmacotherapy alone after T1. To me this suggests that acupuncture doesn't work for the types of pain for which it was being tested. The authors grudgingly concede this possibility too, but can't help but adding some hand waving trying to explain this result:

While pain reduction at T1 was similar for all three groups, patients in the acupuncture group were almost twice as likely to receive rescue analgesia. This may indicate that acupuncture was ineffective and patients sought alternative analgesia or that they were more likely to accept pharmacotherapy because they felt they had missed out on standard care, whereas patients who had already received oral opiates were reluctant to accept parenteral opiates. Patients treated with acupuncture who received rescue medication were classified as having received pharmacotherapy in the PP analysis, in which the equivalence and non-inferiority of groups were maintained, but we cannot discount the possibility that this may partly reflect the potentially self-limiting nature of the treated conditions.

So, basically what we have here is a pragmatic non-inferiority study that is only single blinded that purports to find no difference between acupuncture and pharmacotherapy for several different kinds of pain with different etiologies. (Seriously, migraine headaches are very different from ankle sprains and low back pain.) The lack of full double-blinding easily explains the positive result of the trial as very likely due to placebo effects, after all. Moreover, this study finds significantly increased use of rescue treatments for the acupuncture-alone group, which implies that the the subjects in the acupuncture-alone group were not getting adequate pain relief.

Of course, none of this tops the authors from concluding:

There is a clear demand for analgesia in the ED and a multimodal approach is desirable given concerns about the use of opioids and the potential for addiction. Some Australian EDs already offer acupuncture as an alternative when trained staff are available, and the relative efficacy, acceptability and safety of acupuncture support its playing a role in non-pharmacological analgesia in acute care settings. Acupuncture may also improve patient satis- faction by providing analgesia to patients with contraindications for certain drugs, and for those who prefer acupuncture. Pain management in EDs in general must be improved. The potential role of acupuncture should also be further explored, including determining the conditions in which it is most useful and the feasibility of employing it in emergency settings, including acupuncture training for emergency physicians and allied health personnel.

I'll agree that there's a clear demand for effective analgesia in the emergency room, although for short term use for pain relief opioids are acceptably safe. Increasingly, there has been a narrative among advocates of "integrative medicine" that equates nonpharmacological methods of pain management with woo. What this study does is basically to use the opioid epidemic as an excuse for embracing quackery. Quackademic medicine marches on.

oracknows Tue, 06/20/2017 - 01:53

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https://www.acufinder.com/Acupuncture+Information/Detail/Chinese+Medici…

Categories

Medicine

What am I overlooking here? In an environment where every minute spent doing something like acupuncture is a minute spent not treating the presumably urgent symptoms that resulted in the patient arriving in the emergency room, they are taking the several minutes to stick needles in people? At least the chances of the procedure being interrupted by rude strangers are minimal, so in that regard it's slightly less crazy than battlefield acupuncture. But only slightly.

So the placebo is as good as pharmacology... apart from people in the placebo arm needing drugs anyway when the placebo didn't work. Good to know.

James Coyne is on the case as well.
https://twitter.com/CoyneoftheRealm/status/876903323168681984

"Patients treated with acupuncture who received rescue medication were classified as having received pharmacotherapy in the PP analysis"

Isn't that a huge bias that moves the patients in the most pain into the pharmaotherapy group? Am I missing something?

Example of an emergency acupuncture-like (?) method used to relieve altitude sickness:

It appears acupuncture advocates will do whatever it takes to save lives.

Q. Is the use of fingers in place of needles acupuncture-therapy or massage therapy.

So what they're finding is that placebo effects work sometimes, but nowhere near as well as active ingredients for pain relief?

@Orac-I saw this yesterday. One thing that not mentioned is that, had they included a "sham acupuncture" arm, no difference would have found between the "real" acupuncture arm and the "sham" acupuncture arm (you did write about that more 9 years ago in a previous post, however).

Also, I wonder how supporters of acupuncture will try to explain away the fact that the patients in the acupuncture only arm required more rescue analgesia?

Orac writes that, in the past, he "could imagine that somehow sticking needles into the skin might “do something.”".

Patients get stuck with needles all the time-bloodwork, vaccines, IVs, etc etc. Why would you have thought that being stuck with needles in the context of acupuncture would have had an effect that differed from being stuck with a needle for any other reason?

Which is exactly my reaction to "reiki CPR."

@#6

I was thinking something similar, but I had this vision of a grad student trying to get informed consent from someone keeled over on the floor.

@Jonas #5:

You make a good point, which I can back up anecdotally. Every time a phlebotomist has stuck a needle in my left arm I have felt woozy and have had to look away. Clearly that's a prime example of a qi effect.

So they want to give an ER patient a pneumothorax as well? What good does that do? Ah, I see: "So that we know what's wrong with the patient!"
(A bit like the band I played in as a student, where at every gig, we played some bum notes on purpose -- in the hope that we wouldn't get those real embarrassing mistakes at unexpected moments...).

@Rich Woods, #10

Every time a phlebotomist sticks a needle in my arm I say "When will the results be back?"

Supernatural? Or...

Emergency acupuncture isn't that new. Two of the last three times I was to the emergency room (the first in roughly 2002) I was offered acupuncture services for pain relief. The sell included that it was common and proven (exact wording escapes me, but I recall it sounding like a script both times) This is at a reputable teaching hospital tied to a major university in a metropolitan area. The reason I was there? The first: I was stabbed in the eye and my cornea needed to be reattached. The other? a crushed finger. I pretty much told them where to stick the needles.

I have run out of options for routine veterinary services, though. Within 50Km of my house, there is one practice that does not advertise, prominently, acupuncture. They don't take non-emergency patients. At least I know that in an emergency, there is somewhere to take the cat.

The same holds for chiropractic. Every one of them pushes it. Every. Damn. One.

Let's talk serious risk versus benefit. If the largest trial on acupuncture to date found patients initially treated for acute pain with acupuncture alone had close to twice the likelihood of subsequently requiring analgesic medication as those treated with analgesics alone, why the hell is acupuncture being allowed in the battle field where wasted seconds can make the difference between successfully fending off an enemy combatant and death? Acupuncture? No Sir. Not in my unit.

As a scientist, I can't do anything but cringe at hearing that bullshit about moving patients from the acupuncture group to the pharma group once they need secondary opiates. If patients need a second treatment to stop the pain, that means the first one *didn't work*, regardless of if that was needles, IV drip, pills or prayers.
No wonder they found no difference, all the patients that didn't get better from acupuncture aren't even counted!

Looks like some churnalist at Gizmodo received a press release from Cohen:
https://www.gizmodo.com.au/2017/06/as-good-as-medication-australian-sci…

The spin seems to be "forget all about the primary measure of the study -- pain management -- and let's focus instead on a a small difference on a secondary measure, 'Would definitely repeat treatment -- 48 hours later'." One of many secondary measures, the others being ignored.
I think we can take this as an acknowledgement that the primary measure did not deliver the desired result.

And then the Gizmodo churnalist has the gall (or the stupidity) to spin this as effectiveness "in providing long-term relief". Or perhaps she was just repeating some bullsh1t from Cohen.

After being in an Emergncy Room, I'm not convinced another few needles are going to trigger my body to release any more endorphins. Not having been on the battlefield, but I'll wager, a similair state exists.

What a colossal waste of time and resources. If I'm in pain, I want it treated adequately. There's no way in hell that I would want my treatment delayed for accupuncture.

I'm surprised that only 324 people declined to participate in the study. And given how many people did decline, I'd *love* to look at some demographic data to see if the people who were included were also the kinds of people who are more susceptible to the placebo affect anyway?

Because if you tested acupuncture on people who were already inclined to use it/ believe in it and *even then* it wasn't head-and-shoulders better, well, that's pretty sad.

It never ceases to amaze me how much people's brains shut down about quack medicine like acupuncture.

In a recent article about an engineer with Apple Computer, Scott Forstall claims his life was saved by Steve Jobs' acupuncturist - ignoring of course the months of hospital intervention. He says this without a trace of irony about Jobs' own death from an easily treatable cancer, whose treatment was delayed past the point of no return by Jobs' faith quack medicine.

And of course AppleInsider goes and magnifies the those claims, presenting them as gospel truth: "Forstall revealed Jobs saved his life", the article says, and "The unconventional treatment worked".

http://appleinsider.com/articles/17/06/21/apple-began-project-purple-be…

Is the infiltration of "integrative medicine" into medicine as relentless as we thought? Maybe not...

oracknows — Mon, 12 Jun 2017 00:00:21 +0000

Is the infiltration of "integrative medicine" into medicine as relentless as we thought? Maybe not...

If there's one thing about the march of the pseudomedical entity known as "complementary and alternative medicine" (CAM), "integrative medicine," "complementary and integrative medicine" (CIM), "complementary and integrative health" (CIH), it's that over the last 25 years or so its progress towards being mainstreamed has appeared utterly relentless.

I like to paraphrase Kyle Reese, the warrior from the future sent back in time to save Sarah Connor in The Terminator: "Listen, and understand. That terminator is out there. It can’t be bargained with. It can’t be reasoned with. It doesn’t feel pity, or remorse, or fear. And it absolutely will not stop, ever, until science-based medicine is dead."

And sometimes it certainly seems that way. After all, the number of "integrative medicine" programs in academic medical centers has skyrocketed over the last two decades to over 60, and that doesn't count the many more non-academic medical centers. Meanwhile, Andrew Weil has successfully produced an "integrative medicine" residency that has metastasized far and wide throughout medical academia, while major conferences devote major sessions to "integrative oncology" and respected medical journals publish "state of the art reviews" of pseudoscience and "clinical guidelines" written by naturopaths. There's even a board certification in "integrative medicine," although it's not backed by the usual certification mechanism.

These developments have conspired together to produce an illusion of inevitability to the mainstreaming of "integrative medicine." It's an illusion that integrative medicine proponents actively cultivate, the better to paint opponents as crotchety cynics standing in the way of progress to the perfect integration of the "best of both worlds," to the "marriage of equals" (never mind that the pseudoscience "integrated" into medicine by integrative medicine is anything but equal), to the ultimate in "patient-centered" medicine. Certainly, even to those of us who bemoan the integration of quackery into medical academia to produce what I like to refer to as quackademic medicine, the infiltration of pseudomedicine into medicine often seems unstoppable, not unlike the aforementioned Terminator.

As I survey the continuing advance of pseudomedicine, I can't help sometimes thinking of Arnold Schwarzenegger's voice saying "Hasta la vista, baby!"

However, surprisingly, all is not completely rosy in the world of integrative medicine. I don't know how I missed these articles, which are actually all at least two months old, but I did. They're both by John Weeks, that tireless promoter of integrative medicine whom we've discussed on this blog quite a few times before.

In a couple of columns in (where else?) The Huffington Post, Weeks bemoans the disappearance of two behemoths in the world of integrative medicine. First, he noted Mt. Sinai Merger Shuts New York’s Integrative Medicine “Crown Jewel”. Then he wrote about Wayne Jonas, MD and the Closure of the Influential Samueli Institute: Next Steps. Upon seeing these articles, my thought was: Whoa! These closures are both big deals.

The Continuum Center for Health and Healing: Quackery at its "finest"

Let's take a look at Mt. Sinai first, because the Continuum Center for Health and Healing at Beth Israel Medical Center was one of the examples that first demonstrated to me just how low an academic medical center could go. This center was also sometimes referred to as "Urban Zen" because its creation was funded by Donna Karan's Urban Zen Foundation, created after her husband and business partner, Stephan Weiss, died of lung cancer in 2001. Basically, Urban Zen started out as a whole cancer treatment floor being turned over to "combining Eastern and Western healing methods." As the New York Times put it:

Instead of just letting a celebrated donor adopt a hospital wing, renovate it and have her name embossed on a plaque, the Karan-Beth Israel project will have a celebrated donor turn a hospital into a testing ground for a trendy, medically controversial notion: that yoga, meditation and aromatherapy can enhance regimens of chemotherapy and radiation.

And it spread from there, as you will see, to three floors. Some of the center's webpages have been replaced with an announcement of the closure of the center on October 28, 2016, but there's plenty left of the website so that it's possible to see how in its prime the center offered reiki, Rolfing, prayer, Therapeutic Touch, traditional indigenous healing therapies, acupuncture, even that woo of woo, that One Quackery To Rule Them All, homeopathy. To give you a taste of the "science" supported by Urban Zen, let's take a look at what its homeopath was saying about homeopathy:

People tend to believe that generally the higher a dose of any given medicine, the greater its potency, but the opposite is claimed to be true for a homeopathic remedy. Homeopathic solutions can be diluted to the extent that literally no molecules of the original substance remain; yet according to homeopathic philosophy the more diluted it becomes the greater its potency becomes. Samuel Hahnemann based his theory of how homeopathy works only on the results of experiment and observation. He found that remedies could exhibit their healing qualities only after they were homeopathically potentized (diluted and vigorously shaken). Even after the remedy is diluted beyond the Avogadro number, it remains biologically active, but only if it was potentized. The conclusion was that the biological activity of homeopathically prepared remedies involved energy. Hahnemann suggested that during the process of vigorous shaking (called “successions” [sic] in homeopathy) the energy of the original substance was transmitted to the neutral matter (water) in which it was diluted. The dynamic force which causes the illness and the homeopathic healing, was called “vital force” by Hahnemann. Despite certain experimental evidence that high dilutions of biologically active substances can retain activity if they were vigorously shaken during the dilution process, this issue remains controversial. A unique molecular organization of water has been implemented in its potential ability to transmit biological information.

No, the issue does not "remain controversial." Science has shown that homeopathy cannot work. As I like to put it, for homeopathy to "work," not only would huge swaths of well-supported physics, chemistry, and biology have to be wrong, but they'd have to be spectacularly wrong. Yet, here was a standalone center affiliated with Beth Israel, which at the time was affiliated with the Albert Einstein College of Medicine, spouting off about homeopathy on its website as though homeopathy were more than vitalistic pseudoscientific twaddle. Not surprisingly, Mr. Weeks bemoans what has befallen Urban Zen:

The work at the Continuum Center was leading edge. The team fostered a high level of interprofessionalism and team care. They generated an important body of research. They experimented with business models and experienced times of profitability. Yet amidst a larger economic drama of what was called a merger between Continuum Health Partners and the now dominant Mt. Sinai Medical Center, the formerly 32-clinician integrative center, with its 6,000 visits per month, was put on the corporate chopping block last fall.

Basically, Urban Zen was losing money, and, as its director Dr. Ben Kligler put it, he "totally understands how it looks from [Mt. Sinai’s] point of view. We just looked like another practice in a hospital that was losing money." He blames the closure on bad luck and bad timing:

Kligler views the loss of the Center as “just bad luck.” Why? “[Mt. Sinai] came in when we were the most vulnerable.” Had the merger come through a couple of years earlier, it would have been when the center “was booming.” Kligler explains. In 2012, demand exceeded the ability to fulfill on meeting patient interest. The Center was operating profitably and expanded to a third floor. New investment coupled with new practices not yet overflowing added up to a temporal moment of significant red ink. Had the merger come later, in Kligler’s view, the new configuration would have had time to fill out and flourish. Mt. Sinai caught the snapshot of that moment’s performance rather than considering a promising revenue trajectory. Kligler summed up his view: “Honestly, we can’t hold Sinai responsible. It was terrible timing.”

This explanation, of course, sounds very self-serving. Maybe the Center was on a trajectory to profitability, but, really, when viewing a unit that is losing money most businesses (and, of course, hospitals are businesses) consider whether that unit is likely to return to profitability any time soon and how profitable it is likely to be.

Reading between the lines, I sense that Mt. Sinai either didn't see the Center becoming profitable soon enough for its liking and perhaps didn't have enough interest in maintaining an integrative medicine center. Unfortunately, Mt. Sinai isn't abandoning "integrative" care altogether (which would have been a most excellent outcome). Rather, a core of four physicians relocated to a clinic in West Village (where else?) and that group was apparently lobbying to keep some of the non-MD practitioners previously associated with the Continuum Center (i.e., acupuncturists, naturopaths, etc.). The grants held by the Center transferred to the Mt. Sinai Department of Family Medicine, the better to bolster its standing in quackademic medicine.

Don't feel too bad about Dr. Kligler, though. He's landing on his feet. He's now the new National Director of the Integrative Health Coordinating Center at the Veteran’s Health Administration, where he will work closely with Tracy Gaudet, MD, the director of the Office of Patient Centered Care and Cultural Transformation, to continue what Dr. Gaudet started and infuse the medical care of veterans with a healthy dose of pseudoscience and quackery.

I can't help but picture Schwarzenegger as the Terminator, saying, "I'll be back."

Bye, bye Samueli

I've also written about the Samueli Institute many times. In brief, the Samueli Institute was one of the two sugar daddies for funding the integration of pseudoscience into medicine. It was very influential, as influential as the Bravewell Collaborative, which itself shut down two years ago using the reason that it was no longer necessary, or, as Christy Mack, one of Bravewell's founders put it, "...when our principal strategies had achieved our goals, and when integrative medicine had become part of the national conversation on healthcare, our members collectively decided that it was time to sunset the organization." (Given how thoroughly integrative and quackademic medicine has become entrenched at major academic medical centers, that reason was actually believable.)

So learning from Mr. Weeks that the Samueli Institute will be closing in 2017 shocked me as well. Wayne Jonas, the President and CEO of the Samueli Institute, tried to put a happy face on its shuttering in much the same way that Ms. Mack did for Bravewell, by saying it was no longer needed:

The value of that “somewhere” that Congressional appropriations enabled through the Institute is encapsulated in Jonas’ response on why the Institute was ending operations: “When we started out there really wasn’t much complementary and integrative medicine going on in the VA or the military.” The Institute’s research output and military partnerships led to the seminal 2010 Military Medicine report “Total Force Fitness for the 21st Century: A New Paradigm”. Expansive integrative health research, education and practice initiatives are now presently underway in both agencies, due to this ground work, but without the Institute’s direct presence. Added Jonas: “The work we were doing is now going on inside the DoD and the VA. Our work is not so necessary anymore. What we did has worked. It’s not that I won’t be in touch with them. But what we set out to do is done.” Bridge built.

Again, this excuse is somewhat plausible. There is a lot more integrative medicine around now than there was when the Samueli Institute was formed over 15 years ago. On the other hand, it clearly doesn't tell the whole story:

So why the shut-down of the Institute? Jonas offered a response that felt at once both like putting a nice face on a tough situation, and a spot-on reflection of a job well done. The “nice face” is connected to the Institute’s rapidly declining portfolio of government and particularly military research grants, and the staff to fulfill on them. An Obama-era federal policy change limited members’ of Congress ability to appropriate specific funds to specific entities for specific projects. While Congressional “earmarks” may be considered “pork barrel” when they are for bridges to nowhere, the grants to the Samueli Institute sought to bridge the nation’s medical industry from mono-therapeutic management of disease to a whole system focus on health. That’s a “somewhere” that deserves investment in the United States where the medical industry is the 3rd leading cause of death and at least one-third waste.

Translation: The Samueli Institute apparently relied too much on grants that weren't competitively awarded, as NIH grants are. Instead, it appears to have relied on woo-friendly legislators to send money its way via earmarks, the process whereby individual legislators could "earmark" appropriations to favored entities to do work that a legislator reserving an earmark wanted to support. When those grants dried up, Samueli had an increasingly difficult time staying viable. Also, Jonas had apparently become tired of just administering grants, saying, "I’m not sure that focusing on the minutia of administering large grants is the best use of my skills [The Samuelis and I] decided to take a step back. A lot of our best work has been as catalysts. How can we catalyze what we want nationally? I couldn’t do that and run contracts.”

Of course, like Bravewell, Samueli won't entirely die. It transferred $7 million of grants to the Thought Leadership Foundation, whose mission is: "To promote new and innovative thinking that leads to transformative change in the healthcare, education, economic opportunity and environmental arenas by engaging thought leaders in research, writing and program activities to address intractable problems plaguing those communities." On the surface, TLF doesn't look that woo-ful an organization. It supports initiatives in autism; translational medicine’s impact on treating Traumatic Brain Injury (TBI), Lyme disease, HIV/AIDS, other chronic diseases; renewable energy sources; mobile medical care plans; and other environment- and medicine-related projects. There doesn't appear to be much, if anything, about integrative medicine on its website. I rather suspect that that will change, though. Mr. Weeks notes that TLF "saw huge growth with the transfer of the Samueli Institute’s research portfolio, quadrupling TLF’s size." This suggests that Samueli's "integrative medicine" portfolio is taking over TLF.

So basically, the Samueli Institute won't really die either, nor are Jonas and the Samuelis going away:

Serving as a catalyst is the seed of what Jonas will bring forward in his next phase of partnership with the Samuelis. “Dialogue about integrative health care will not be the focus, but integrative health will be at the table, in the mainstream.” (Notably, this was already modeled with in the project that will be carried by IHI, where integrative health representatives served on the steering committee.) Moving forward, their goal will be to “catalyze nationally some of the work we have been doing.” Approaches such as social impact investment may be considered, together with not-for-profit initiatives and other business models. “We are moving,” he said, “toward a more convergent platform. We are thinking about how we can accelerate this movement.”

I'm not sure exactly what that word salad is supposed to mean, other than that Jonas and the Samuelis will use the Samueli money to do something else to promote the integration of quackery into medicine. The Terminator's voice again echoes in my head, "I'll be back."

A fit analogy?

On the surface, the events I've described, the closing of the Continuum Center, of the Samueli Institute, of Bravewell, seem to indicate that maybe integrative medicine isn't the unstoppable juggernaut that we skeptics portray it as. Indeed, these aren't the only examples. In his article about Mt. Sinai, Mr. Weeks notes that other centers had shut down too, while in an article published at the end of 2016, he noted:

To the budgets of the multi-billion juggernauts of the US medical industry inappropriately styled as “healthcare systems,” integrative medicine is - as a colleague suggested recently - a “rounding error.” And as has become clear over the past two decades of multiple shuttering of significant integrative centers, a profound economic misalignment exists between the “volume-based” and technology-driven industry and the mission-and-value orientation of relatively low cost, human-intensive, integrative care. Still it was a shock when word came out - apologies, I am part way into writing this story - that the powerfully influential Continuum Center for Health and Healing no longer fit into the plans of its parent, the $3.5-billion, plus, Mount Sinai Health System. Meantime, when the $7-billion Banner Health took over University of Arizona Medicine they showed no interest in the Phoenix-based Arizona Integrative Health Center where the Andrew Weil-founded Arizona Center for Integrative Medicine anticipated proving integrative health’s business model as a low cost option for chronic disease. Be aware: another shoe is about to drop. Each, notably, was showing patterns of positive outcomes. Are these centers simply a misfit with the industrial focus of the volume based system?

I'm guessing that the "other shoe" to which Mr. Weeks referred at the time was the closing of the Samueli Institute, which hadn't happened yet. Mr. Weeks is, of course, quite attuned to what's going on in the world of integrative medicine; so likely he had inside information that the closure was going to happen. In any case, you get the idea.

Although the pseudoscientific practices in integrative medicine are often perceived as a license to print money (and sometimes they are), because insurance doesn't reimburse for them it can be much harder to build a sustainable business model providing such services than you'd think. That's one reason why integrative medicine advocates lobby so hard to license naturopaths and to have laws passed requiring that services like acupuncture, traditional Chinese medicine, and the like be covered by health insurance plans.

It's why Sen. Tom Harkin inserted a clause in the Affordable Care Act requiring insurance plans sold through federal exchanges to cover the services of specialties licensed by the state, such as naturopathy, chiropractic, and acupuncture. So basically, what integrative medicine practices can bill insurance companies for are the services they provide that are the real medicine into which they are integrating their quackery. The problem, of course, is that those services are not well-reimbursed (as any cash-strapped primary care practice can tell you), and apparently the "cash on the barrelhead" integrative medicine services don't make up the difference, particularly given how one of the main appeals of integrative medicine is how much time practitioners spend with patients, which greatly limits the volume they can see.

Unfortunately, there are those who have figured out how to make money integrating quackery into medicine:

This article is one in a series on significant ups and downs with major centers. We see significant expansion at Jefferson in Philadelphia, a new 17,000 square foot space for the Center for Functional Medicine at the Cleveland Clinic, and system-wide integrative health at Meridian Health. The build-up of integrative health and research in the Veterans Administration with which Kligler is now involved is another bright light.

Yes, the Cleveland Clinic is one such institution, and I've written many times about it. Some have even joked about it. I still think that The Terminator is an excellent analogy for integrative medicine, though. When the Terminator says, "I'll be back," he always does come back. The Terminator is usually destroyed at the end of each movie, but somehow he's always back in one form or another in the next.

I have no doubt that the closure of the Samueli Institute and other major integrative medicine centers will only slow the advance of pseudoscience infiltrating medicine; that is, unless medicine starts to value science over pseudoscience and stops falling for the false narrative that you have to "integrate" quackery in order to take care of the "whole patient" in a patient-centered manner. I'm not holding my breath waiting for that…

“Fear not. I’ll be back…in Terminator 3!”

oracknows Sun, 06/11/2017 - 20:00

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Chen and Michalsen describe it thusly:

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The work at the Continuum Center was leading edge. The team fostered a high level of interprofessionalism and team care. They generated an important body of research. They experimented with business models and experienced times of profitability.

[looking at my Buzzword Bingo card] BINGO!

Seriously, I'm pretty sure they're misusing the word "continuum", and I haven't the foggiest idea what "interprofessionalism" is supposed to mean. "Experimenting with business models" is usually considered a bad thing, at least from an investor's point of view. And businesses are expected to "experience times of profitability." As for their research, I doubt it's worth the paper it's printed on.

Several years ago a friend had eczema and found little relief from science-based medicine.

Seeking alternative medicine, a "professional inquisitor" wrote a word(s) on a piece of paper and asked him to hold it with a firm grip.

If his heart rate increased this was evidence of an atypical response and the written word(s) on the paper was a clue to his ailment and suffering.

In this diagnostic situation, "graphite" was revealed to be a bio-sensitive word and medications were prescribed thereafter.

The phrase "I'll be back" sounds great in the Terminator movie but not-so-great in some aspects of medicine.

@ Orac,

We need you back...

These developments have conspired together

To 'conspire' means to 'breath together'. Redundant. Wouldn't collude be a better word?

Some forms of CAM (more maybe sCAM would be a more accurate description) have gained such wide public acceptance that I actually feel like I'm in the minority, knowing that they are worthless.

Acupuncture and chiropractic seem especially widely accepted by the public, and my insurance covers both, despite zero evidence that acupuncture is effective (and a total lack of biological plausibility) and, very limited, at best, evidence for chiropractic.

It's really surprising that so many people fail to grasp that acupuncture *cannot possibly* have any effect, since acupuncture is based entirely on prescientific notions. Really, it's no more biologically plausible that acupuncture has any effect on anything than that homeopathy (or, as Orac accurately calls it, "The One Quackery to Rule Them All) has any effect on anything.

Yet acupuncture has gained significantly more "legitimacy" in the eyes of the public than homeopathy has...I wonder why that is? It is not scientifically possible for either to have any effect.

Actually, I should have added that "reiki" and other forms of "energy medicine" woo are just as obviously unscientific as acupuncture and homeopathy. "Nambudripad's Allergy Elimination Techniques" is another example of rank quackery that is very obviously not based in science. Why some people fall for this stuff is beyond me...

@Jonas: I am more forgiving of acupuncture in this regard than homeopathy or reiki. The latter two are nonsensical on their face: there is no mechanism consistent with chemistry and physics that would allow either of them to work. Acupuncture has indeed been shown in studies to be ineffective, but those studies actually needed to be done, because it was possible (even if unlikely) that there was a causal mechanism--what the studies showed is that no such causal mechanism exists.

@Eric Lund-Considering that acupuncture is based on a pseudo-scientific belief system centered around nonexistent "chi", "meridians", and "qi", I don't think that there was ever any possibility that there was any real causal mechanism through which acupuncture could have any effect on anything (except, of course, the placebo effect), and therefore I don't see why there was ever a need to waste $$ studying it.

I mean, the acupuncturists themselves never put forth any potential plausible mechanism through which acupuncture would work-they stated that it "works" by altering the flow of "qi", which does not exist-so, I have to respectfully disagree with you on this.

It would be great if the Terminator turns out to be a good metaphor for IM. After Sarah finally crushes Arnie after much destruction in the first film, he comes back as young John Conner's protector in T2. The basic, and I think original idea of 'integrated medicine' was a good one: The things to be integrated weren't sbm and quackery, but physiological medicine and a not-necessarily-quacky concept of 'whole patient care' — psych services, lifestyle issue (e.g. diet, exercise etc.) counseling and support, "supportive care" etc.
But then the CAMmies like Weeks, Weil, Hyman et al appropriated the term for their agenda, and it became the dominant meaning in circulation.

I've seen signs before in a few of Orac's posts that here and there that at least some institutions going the IM route actually has the horse before the cart. That is, they have worthy goals in terms of patient care that are their motive force, are trying some CAM stuff to achieve them, but then doing a fairly sober analysis of the results, and concluding that the CAM doesn't get the results they'd hoped for, while the other sorts of stuff I mentioned above does. Not that they've turned on a dime as a result, but there did seem to me to be hope, and now there's this...

Unlike many commenters here, I'd guess, I have personal experience with a non-quacky 'integrated medicine' program. When I decided to go for bariatric surgery, my PCP sent me to a surgery practice in another city an hour or so down the road that had the best rep in the state (much better than any of the local surgeons...). Before the doc would cut, we had to meet with a psychologist and get approved by her, had to attend support group sessions, and had to work with a dietician to show we could do the post-op diet regimen and lose some weight on our own to give the surgeon less to cut through. Then, after the surgery, in addition to medical follow-ups with a PA, it was more meetings and supervision with the dietician, and more support group meetings to help us adjust and monitor how well we were coping psychologically with our changed bodies. If we fell back on any of this, we got phone calls until we caught up. As convinced of the superiority of his surgical skills as the doc was, he still attributed his way-above-the-norm success rate to this 'holistic' program, (not that he used that term, fwiw).

This makes me wonder about what evidence standards validate any 'integrated' approach. For Dr. A. it was a matter of comparative success by the the standard measures used in that specialty. But I wonder if any of the individual components would pass a hard science test on their own. It is possible, and maybe likely, the components act in synergy. To be fair, I'd have to admit that this could be true of CAM components included in some IM programs, where they function as a form of psychological 'supportive care' regardless of how they're framed. Acupuncture, e.g., may be 'worthless' on it's own, but still play some positive role in the synergy – a not-really-medical function that still contributes to improved medical results, like the support groups.

My first concern about the CAM then is not that it 'doesn't work', but that it doesn't work for everyone. That could be covered somewhat by having a menu of different 'modalities' available, including not scientifically improbable ones like yoga e.g., such that more patients would likely to find some form of theater in there that speaks to and 'works' for them. My second concern is that even where such variety is available, the more purely CAMmy methods may not be the best or most cost-effective choices for some or all of the patients, compared, say, to something like support groups, or maybe art/music therapy(?). Again, to be fair, I have to admit that some institutions may be going with CAMMy stuff that would turn out to be sub-optimal because that's where the hype and funding is to get any sort of 'whole person' approach off the ground...

What important, I think, is not to throw out the value of 'integrating' supportive measures and therapies into medical treatments that have eschewed them by convention with the bathwater of the worst 'IM' approaches...

Also, it's worth noting that reiki is also based on the belief in the mythical "qi", just like acupuncture. Therefore, since you agree with me that reiki is nonsensical on it's face, I would have expected you'd have said the same about acupuncture, since both are based on the same myth.

Personally, I think homeopathy, as well as *all* forms of "energy medicine" (including acupuncture) are nonsensical on their face, and there was never any reason to study any of them.

If there is no possible mechanism of action (and there isn't with any of the "treatments" I mentioned), there is no need for studies in my opinion.

The only real difference between acupuncture and the other quack treatments I mentioned is that it has gained some degree of legitimacy in the eyes of many people, whereas the other quack treatments have not (at least in the U.S.-in the U.K., the NHS actually wastes $$ giving "homeopathic remedies", aka sugar pills, to the gullible-a huge waste of $$ that is especially difficult to justify when you consider that the NHS refuses to fund Everolimus treatment for cancer). patients.

Acupuncture involves the physical act of sticking needles in somebody. It would be surprising if that did not produce some kind of response in the patient. Whether that response differs from the placebo effect is not obvious on its face. That's what the studies were for: they established that the effect is indeed a placebo. The underlying explanation that acupuncturists give is obvious nonsense, but so is the idea that you have to pray to a rain god to get water from the sky to fall on your crops. Sometimes rain does fall on your crops. Or to take a more recent example, combustion does not involve the release of phlogiston. Just because the proffered explanation is nonsense is not sufficient to conclude that the underlying phenomenon is nonsense.

Contrast homeopathy, which involves diluting your alleged active ingredient to the point where it's statistically unlikely that even one molecule of it is in the pill, or reiki, which involves healing without requiring physical contact. An ordinary high school student should be able to see that there is nothing there.

@ Jonas

Acupuncture does have an effect, as the public defines "effect". In some concretely valuable ways, if you feel better you are better, i.e more capable of getting on with your everyday life, which may include difficult measures of compliance with a medically beneficial regimen. Of course, feeling better is no substitute for medical procedures that actually help you get physiologically better, but that's why "integrative medicine" isn't the same thing as 'alternative medicine'. In the terms of Orac's favorite analogy, the latter has no apple pie at all, and the former has a proper slice.

And you are simply incorrect that 'qi' is the only explanation for acupuncture. See, e.g. the sponsored insert on TCM in Science or the discussions of needling in Consumer Reports.

Do note that I'm not advocating acupuncture. On the contrary, I'm critiquing your argument against it because it's weak at best when not just wrong, and easily refuted by acu-advocates to the judgement of the non-scientist publics and policy makers who make decisions on this stuff.

So the giant scientific medical centers chopped these programs strictly on monetary grounds, without any review of their efficacy?

Sometimes I think our esteemed host barks up the wrong tree in pursuit of what goes wrong in US medicine...

Quackery invades another once science-based journal

oracknows — Tue, 30 May 2017 01:02:36 +0000

Quackery invades another once science-based journal

Surprisingly, I made it through an entire three day weekend without posting anything to the blog. Believe it or not, this is a good thing. It means that I actually worked on my grant that's due at the end of the week. Still, a blogger's gotta blog; so I can't just shut down until the end of the week. So, hwere we go.

I've long lamented the creeping infiltration of quackery into medical academia in which modalities once considered quackery, such as acupuncture, reiki, naturopathy, homeopathy, and various other dubious treatments, have found their way into what should be bastions of science-based medicine (SBM). Over the years, I've noted the proliferation of "integrative medicine" programs and residencies in medical academia, and professional conferences, the credulous teaching of "complementary and alternative medicine" (CAM) modalities as part of the normal medical school curriculum. (Georgetown University even had a program where acupuncture meridians and points were taught during gross anatomy.) Basically, CAM has been a Trojan horse for quackery in which appeals to more "humanistic" medicine and emphasis on diet and exercise have lured medical schools to bring the giant horse in, after the doors on the bellies of the Trojan horses opened to disgorge quackery such as naturopathy, homeopathy, acupuncture, reiki, and even anthroposophy.

Besides the enthusiastic embrace of quackery by large, respected academic institutions like the Cleveland Clinic and Memorial Sloan-Kettering Cancer Center, this "integration" of quackery with medicine has manifested itself in medical journals. Once hard-nosed, science-based medical journals have, unfortunately, started publishing what can only be described as credulous endorsements of quackery. Indeed, I've documented many examples of this shameful phenomena over the years, but I'm about to document a whopper of an example now in, of all places, The BMJ, which has recently published two "state of the art reviews" on "integrative medicine" that can only be described as fully buying into the false paradigm that quackery needs to be "integrated" with medicine. The first "state of the art review is about the management of chronic pain using complementary and integrative medicine by Lucy Chen from the Massachusetts General Hospital Center for Translational Pain Research and Andreas Michalsen from the Institute for Social Medicine, Epidemiology and Health Economics and Immanuel Hospital in Berlin. The second is about complementary and integrative medicine in the management of headache by Denise Millstine, Christina Y Chen, and Brent Bauer, all from the Mayo Clinic. Sadly, both Harvard and the Mayo Clinic have become bastions of quackademic medicine.

The evolving language of "integrative medicine"—or whatever they're calling it this week

One of the most striking things about both of these articles is the term their authors chose to use to describe what was once "CAM" or "integrative medicine": "complementary and integrative medicine" (CIM). It's an odd choice that seems a bit out of sync with what is going on in quackademic medicine these days, as I will describe. But first, let's take a look at what I'm referring to.

The concept of complementary and integrative medicine (CIM) encompasses both Western-style medicine and complementary health approaches as a new combined approach to treat a variety of clinical conditions. CIM may have a unique role in chronic pain management because the multidimensional nature of the pain experience requires a multimodality treatment approach. Recent advances in basic science and clinical research on CIM have substantially increased patients’ awareness about the potential therapeutic use of CIM.

Note the false dichotomy, in which "Western" (i.e., European) tradition is presented as scientific, reductionistic, and lacking in humanism, compared to "CIM," which is the opposite.

I've been noticing a new step in the evolution of language about CAM, and this is another part of it. It first struck me when the National Center for Complementary and Alternative Medicine (NCCAM) first proposed renaming itself to the National Center for Research on Complementary and Integrative Health. The actual name NCCAM took, as we all know now, was the National Center for Complementary and Integrative Health (NCCIH). This is just the latest iteration of rebranding quackery to try to make it respectable by calling it something else, and the BMJ articles contribute to this rebranding. Let's look a bit at the history.

Around a quarter century or so ago, as part of a conscious effort to make quackery respectable, the term alternative medicine morphed into "complementary and alternative medicine" (CAM). The process continued, such that around 15 years or so ago, the term "CAM" then "evolved" into "integrative medicine." Each name change was an intentional use of language that served two purposes. First and foremost, the goal of CAM advocates has been for their pseudoscientific treatments like acupuncture, reiki, "functional medicine," and the like to come to be seen by physicians and the public as legitimate medicine, rather than the rank quackery that many of them are. Second, such terms have facilitated the co-optation of real, science-based treatments (such as those involving dietary manipulation and exercise) as somehow being "alternative" or "integrative." The reason, whether acknowledged or not, for lumping such treatments together with quackery is because "lifestyle" treatments (such as diet and weight loss for early type II diabetes) can be science-based and can work. They thus provide a patina of respectability to all the other nonsense that gets lumped together with them as "complementary" or "integrative."

It's telling to note how the terms evolved. I've discussed this in detail on several occasions over the years, but it's worth a brief recap. Way back in the mists of time (say, the 1980s) there was alternative medicine. Alternative medicine was (and, when the term is used, still is) medicine that does not fit into the current scientific paradigm, a term used to describe medical practices that were not supported by evidence, were ineffective and potentially harmful, and were used instead of effective therapies. Instead of giving up therapies without evidence to support them, however, alternative medicine practitioners rebranded them as "complementary and alternative medicine" (CAM). Over a relatively brief period of time, the name change had its intended effect. No longer did many physicians automatically view modalities that were once considered quackery, later considered “alternative,” and now considered “CAM” as quackery, and those who still did were dismissed as close-minded, stubborn, and dogmatic, relics who were trying to stop what was clearly the future of medicine. The term "complementary", however, soon became a problem.

Thus, back in the mists of time (say around the late 1990s to early 2000s) was born a new term: "integrative medicine." No longer were CAM practitioners content to have their favorite quackery be “complementary” to real medicine. After all, “complementary” implied a subsidiary position. Medicine was the cake, and their wares were just the icing. That wasn’t good enough. They craved respect. They wanted to be co-equals with physicians and science- and evidence-based medicine. The term “integrative medicine” (IM) served their purpose perfectly. No longer were their treatments merely “complementary” to real medicine. The very intentional implication, was that alternative medicine was now co-equal to science- and evidence-based medicine, an equal partner in the “integrating," and that "integrative medicine" combined the "best of both worlds" (Cue the Locutus of Borg jokes). Of course, I like to refer to such "integration" of pseudoscience into medical academia as "quackademic" medicine.

Then came the NCCIH, which broadened the term to gauzy near-meaninglessness. "Integrative health"? Just what the heck is that? Why get rid of the word "medicine"? Obviously, the intent was to expand the meaning to encompass nearly anything health-related and to further blunt any concerns that pseudoscience is being used instead of SBM (although, contrary to what CAM promoters claim, it is). Indeed, I've started noticing the term "integrative health" popping up more and more, supplanting "integrative medicine."

All of this is why I found the choice of the term "CIM" to be so odd. Thus far, every step in the evolution of nomenclature for CAM or "integrative medicine" (or whatever you want to call it) has been to make it more and more indistinguishable from real medicine, to lessen its dependence on real medicine, to sell the pseudoscientific modalities embraced by integrative medicine as being co-equal with real SBM. As part of that messaging and rebranding, CAM has positioned itself as a means of "nonpharmacologically managing" pain and a large part of any potential solution to the opioid addiction epidemic, messaging that's been going on at least five years, is part of the NCCIH's strategic plan, and has been so successful that even the FDA is buying into it. Going from "integrative medicine" to "complementary and integrative medicine" would seem to be a step backward, a step back towards terminology in which SBM is the real medicine and "CIM" is just the icing on the cake.

Millstine et al explain it this way:

Conventional treatments, particularly drugs, are often effective in resolving acute headaches and reducing the frequency of chronic or recurrent headaches. However, many patients turn to complementary and alternative medicine (CAM) for greater improvement. CAM has evolved over time but it generally includes treatments that are not typically considered part of conventional medicine. Examples include massage therapy, acupuncture, mind-body medicine, and the use of botanicals and supplements. The distinction between CAM and conventional medicine, however, is not always clear, as is the case with several over the counter supplements now commonly recommended by conventionally trained providers, such as magnesium supplements in migraine.

However, partly as a result of research support by organizations such as the National Center for Complementary and Integrative Health (NCCIH), a growing body of literature has shown that many CAM therapies are effective when used in conjunction with conventional care.³ This has led to the use of the more appropriate term, complementary and integrative medicine (CIM), reflecting the fact that evidence based CAM therapies are increasingly being incorporated into conventional care. The Academic Consortium for Integrative Medicine and Health notes that integrative medicine “reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic and lifestyle approaches, healthcare professionals and disciplines to achieve optimal health and healing.”

My head hurts after reading that. After all, the term "CAM" was originally coined to assuage the doubts of doctors who feared that alternative medicine was being used instead of conventional SBM. That was the very purpose of the term. One of the references the authors cite is an NCCIH web page entitled "Complementary Health Approaches for Chronic Pain: What the Science Says." Let's just say that it doesn't really provide compelling evidence that "many CAM therapies are effective when used in conjunction with conventional care." Even if it did, the renaming is still…curious. In essence, it does what we have been doing all along here and equates the word "integrative" with "alternative." In essence, it almost admits to the linguistic prestidigitation that turned "complementary and alternative" to "integrative" medicine. One wonders if a lone science-based holdout editor at the BMJ forced the authors to use this term as a subtle joke. Whatever the reason for the term CIM, Edzard Ernst agrees with me that "CIM" is a nonsensical term.

But what do the articles say?

One more time: Nonpharmacologic treatments for pain ≠ CAM, CIM, or whatever it's called

The article by Chen and Michalsen on CIM for pain is long. It clocks in at well over 18 pages, although over five of those pages are references, which brings up something that Ernst also mentioned, namely how much the authors strive to give the appearance of scholarship. After all, a lengthy references section equals strong scholarship, right? Wrong. To cite an extreme example, I can point to antivaxers who write articles with dozens of references. Indeed, one of them, Ginger Taylor, likes to list well over 100 references that supposedly support her view that vaccines cause autism. They don't, as the articles she cites as supporting a causative role for vaccines in autism do nothing of the sort and the ones that she cites that do support a causal role are uniformly crap. No, I'm not saying that Chen and Michaelsen were that bad. I only chose the example I did as a very extreme example. I mean only to point out that quantity of references do not equal high quality science and to reinforce Ernst's point that this article left out a whole lot of negative studies, cherry picking "only evidence for the efficacy of the treatments they promote."

One thing that struck me about this review is that it was weighted very heavily towards either rheumatoid arthritis or studies of back or neck pain, which is not entirely unreasonable given that back and neck pain are very common. Another thing that struck me about this article right away is that it is how heavily weighted towards acupuncture it appears, with a large table of studies that supposedly establish efficacy of acupuncture for pain. Fortunately, I just wrote about acupuncture last week and a couple of weeks before that, so I don't have to go into much detail as to why the evidence cited does not support the efficacy of acupuncture for pain. Basically, the larger and better designed the clinical trial, the less likely it is to show an effect of acupuncture above placebo. Acupuncture is theatrical placebo.

None of this stops Chen and Michalsen from enthusiastically embracing it, even buying into the multiple odd ways that acupuncturists combine acupuncture with other "treatments," from potentially science based (electroacupuncture, which is really just transcutaneous electrical nerve stimulation, or TENS, with needles) to bee venom:

Bee venom acupuncture falls into the category of herbal acupuncture, which combines the effect of bioactive compounds isolated from bee venom with acupuncture stimulation. Several meta-analyses found limited evidence assessing its effectiveness. Pain was lowered significantly more with bee venom acupuncture than saline acupuncture (n=112; weighted mean difference on 100 mm visual analog scale 14.0, 95% confidence interval 9.5 to 18.6, mm; P<0.001). However, the limited number, low quality, and small size of the RCTs make drawing conclusions difficult.^73‑75

This is basically a very silly and unreliable way of administering a potentially pharmacologically active compound.

Another section of the review covers "mind-body" therapies. I always find this category problematic, because, as is the case with much "CIM," it lumps together techniques that could be science-based, such as exercise, with other modalities that are probably not. Inevitably, the "body" part of mind-body modalities always emphasizes "exotic" forms of exercise, such as tai chi, quigong or yoga, over more mundane forms, such as walking or gentle aerobic exercise. For instance, early mobilization is recommended in the treatment of back pain now, and these forms of exercise are just more "sexy" ways of achieving that. In any event, the best that Chen and Michalsen could conclude is that yoga and tai chi might be beneficial, while the evidence for qigong was more conflicting.

Chen and Michalsen are also very much taken with supplements, herbal medicines, and dietary manipulations. For instance, they recommend the Mediterranean diet, citing a small randomized controlled trial and a larger nonrandomized controlled trial as evidence of its efficacy, both of which were thin-gruel indeed, scientifically speaking. Unfortunately, they also included a dubious dietary intervention, elimination diets:

Among a broad variety of food and nutrients that are associated with increases in disease activity, meat, milk and dairy products, wheat gluten, citrus fruit, alcohol, and coffee are ranking high.^{172 173} Doctors may encourage patients to find individual associations and try individual elimination after confirmation by re-challenging. Clinical research in elimination diets is difficult and complex to perform. So far, only one RCT with 53 patients has examined the concept of an elimination diet with a complex study design, including an initial washout period and specific responder analyses.¹⁸⁸ Foods least likely to cause intolerance were reintroduced first in a stepwise manner, and any foods inducing symptoms of rheumatoid arthritis were removed from the diet. There was a significant reduction in pain with the diet in both groups during the dietary elimination phase, but differences between groups were not reported.

Elimination diets are a favorite of naturopaths who like to think that all disease is traceable to diet or various food "allergies." It's at best dubious and at worst quackery. (Let's just put it this way; Gwyneth Paltrow is a fan.) Elimination diets are rarely based on properly conducted allergy testing. Indeed, the testing used to determine what foods to "eliminate" is not scientifically supported.

If you want an idea of how credulous Chen and Michalsen are, look no further than this passage:

This treatment was evaluated in a cohort study and a further prospective non-randomized comparative study. The comparative study included 86 patients with back pain and compared a complex anthroposophical therapy with the standard approach, finding comparable improvements in both groups after six and 12 months for pain, function, and quality of life.²¹⁴ A longer term cohort study that assessed effects of anthroposophical medicine in 75 patients with chronic back pain found sustained benefits after two years.²¹⁵ Future randomized trials are warranted.

Anthroposophic medicine is mystical hooey created by Rudolf Steiner. It's a medical "system" (if you can call it that) that is at the bottom of a lot of quackery and antivaccine beliefs. It also encompasses biodynamic farming, which involves actions like stuffing cow manure into the horn of a cow and burying it in the autumn, leaving it to decompose during the winter, and taking crushed powdered quartz and stuffing it into a horn of a cow to bury in the spring until autumn, supposedly to control fungal diseases. You get the idea. No wonder I was so depressed when anthroposophic medicine showed up at my old alma mater.

Any review that takes anthroposophic medicine seriously is not a serious review.

All this woo is giving me a headache

The second review, by Millstine et al. suffers from many of the same issues as Chen and Michalsen's review. For instance, it is very much as acupuncture-heavy and credulous. It even goes into auricular acupuncture, explaining it thusly:

Hand, ear, and scalp acupuncture can be more accessible than traditional acupuncture in various clinical settings. The ear holds a microsystem of the body, where stimulation of specific points on the external surface of the ear may provide therapeutic relief of symptoms that are connected to the body system (fig 2).²⁸ Ear acupuncture, for example, can be performed quickly with the patient sitting upright and fully clothed. An RCT of 94 women with migraine without aura compared ear acupuncture in a therapeutic area with treatment in an area deemed unlikely to be beneficial. VAS was significantly reduced 10 minutes after needle insertion time and the effect lasted for two hours (P<0.001).²⁹ Another RCT compared ear acupuncture with traditional acupuncture in 35 patients with migraine without aura. The severity of pain (using the migraine index) was reduced after eight weeks of weekly treatments; it was significantly improved from baseline and both groups were comparable after treatment and three months later (residual pain 54.83% and 63.43% for somatic and ear acupuncture, respectively). After six months residual pain was 16.80% and 48.83% for somatic and ear acupuncture, respectively (P=0.038). These results were confirmed by the visual analog scale test and by the evaluation of pain threshold.³⁰

My brain tuned out after I read the part about the ear holding "a microsystem of the body" and how "stimulation of specific points on the external surface of the ear may provide therapeutic relief of symptoms that are connected to the body system." Actually, my brain didn't tune out enough not to notice that the trial cited appears to have had no sham control group and compared regular acupuncture to auricular acupuncture. I don't have online access to the journal in which the article was published, but it also appears not to have been double-blinded. Placebo effects are therefore highly suspected as the reason for the results. (Yes, this appears to have been a comparative effectiveness trial.) Back to the silliness of ear acupuncture. Remember, auricular acupuncture basically assumes a homunculus on the ear whose parts map to organs and other body parts. It is just as scientific as reflexology, and reflexology is utter pseudoscience. Millstine et al. leave out the homunculus, but they do include an illustration of an ear that shows parts of the ear mapping to the same parts that the traditionally drawn homunculus does. Despite its utter pseudoscience, unfortunately there are military advocates who are successfully integrating auricular acupuncture into the treatment of wounded soldiers and veterans in general as "battlefield acupuncture." It's been a wildly successful effort, unfortunately.

The rest of the review reads very much like that of Chen and Michalsen, listing "mind-body" interventions, botanicals, diet, and the like, with very little compelling evidence presented for efficacy and no mention at all of the extreme implausibility of so many of the treatments. In doing so, Millstine et al. propagate the idea that there's something about diet and exercise that is somehow "integrative" or "complementary" when dietary interventions and exercise, when used in a manner supported by sound science and evidence, are just medicine.

None of this stops Millstine et al. from concluding:

The use of CIM therapies has the potential to empower patients and help them take an active role in their care.^{90 91} Many CIM modalities, including mind-body therapies, are both self selected and self administered after an education period. This, coupled with patients’ increased desire to incorporate integrative medicine, should prompt healthcare providers to consider and discuss its inclusion in the overall management strategy.

Wait a minute. The evidence base for CIM strategies for migraine is low quality, but providers should recommend it because they "empower" patients and help them take an active role in their care? What a false dichotomy! Empowering patients and getting them to take a more active role in their own care do not require prescribing unscientific treatments with no compelling evidence for their efficacy. In other words, accepting quackery does not equal "patient-centered" care or "empowering" patients. These desirable outcomes can and should be achieved while recommending science-based medicine.

Count The BMJ among the fallen

With the increasing infiltration of quackery into medicine in the form of CAM, or "integrative medicine," or "CIM," or whatever you want to call it, we are seeing more and more journals succumb to the temptation to publish nonsense like these two review articles that appeared in The BMJ. In this case, it's particularly puzzling, given how The BMJ has a history of publishing articles decrying the overhyping of acupuncture and warning about acupuncture-transmitted infections and potentially serious adverse events. It's also published articles with titles like "The scam of integrative medicine", "Integrative medicine and the point of credulity", and "Doctors warn of dangers of complementary medicine for children." It has also published credulous articles as well, but seldom, as far as I can tell, as "systematic reviews" as obviously biased as these two are.

Prof. Ernst is justifiably unhappy. As he says, The BMJ used to be a good journal. What is happening? Sadly, I think I know. The tide of pseudoscience that has been rising over the last quarter century has simply engulfed The BMJ too. At least in this case there has been some pushback, but I fear it will be short lived. In the meantime, I eagerly await The BMJ's next systematic review on the use of CIM to treat patients with a vague sense of unease or a touch of the nerves or even just more money than sense. I'm sure it will be equally positive as the reviews by Chen and Michalsen and Millstine et al.

oracknows Mon, 05/29/2017 - 21:02

Tags

Clinical trials

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Categories

BMJ = British Medical Journal (acronym not expanded in the above blog-post). CAM = Complementary and Alternative Medicine (expanded not at first mention above, but further down). Please, science writers, take pity on your readers and expand each acronym at the first instance when you use the acronym.

Note the false dichotomy, in which “Western” (i.e., European) tradition is presented as scientific, reductionistic, and lacking in humanism, compared to “CIM,” which is the opposite.

A false dichotomy with roots in a bad translation of Chinese to English. The Chinese didn't have a word for the sort of science-based medicine that Westerners practiced, but they could see that it was Westerners who practiced it. Which is why they called it xi (Western) medicine, to distinguish it from the more traditional zhong (Chinese) medicine. A literal translation from Chinese to English will therefore call SBM "Western medicine", which loses the nuance of the Chinese term. From there, all it takes is a little propagandizing.

According our academic world, the BMJ is becoming better and better:
Journal Impact Factor:
2013: 16.4
2014: 17.4
2015: 19.7
If they include an Astrology section they will attract readership and do even better.
Our academic institutions rely on Numerology.

"compared regular acupuncture to auricular acupuncture"

When treating someone with a placebo I suppose it's good to use the very best placebo. With reiki one can compare waving of the right hand vs the left hand.

Ooops! According to....

This isn't new. BMJ has promoted various forms of quackery off and on for years.

This stuff is frustrating to me as a chronic pain sufferer-- fibromyalgia, back spasms, and a number of other things. My mother unfortunately was big into woo when I was going to grad school and living with them to save money; my insurance back then wouldn't cover massage for the back spasms and other muscle issues, but my mom would cover me going to see her acupuncturist, who did give a very, very good massage along the back after she was done sticking needles ineffectually into me.

The acupuncturist was a nice enough woman, and didn't pressure too much, but it was always so depressing that I couldn't get funding for a simple thing to improve my life other than endless iterations of hydrocodone, tramadol, and lyrica. I just wanted-- and want-- to live without 24/7 pain ranging from background levels like a constant irritant to 'curl up and cry'. I don't want to have MORE holes poked in me, or funding/interest devoted to what amounts to attempts to do alchemy or sorcery and call it science.

It gets worse. Up here, marijuana is legal and at least for nighttime relief, it seems to have a very strong effect. The NP at the pot shop I go to, thankfully, doesn't promise miracles, just potential relief, and because of the eff up our laws are at right now, neither they nor the companies that make the stuff can make pills of the actual effective ingredients. She taught us how to make them, but with my hands trembling all the time, that's one more ride on my wife's shoulders. And that's not even counting the fact that effectiveness and percentage of active ingredients in the original syrupy stuff they sell isn't super-consistent from crop to crop, because of course, these are all tiny little operations. There are some good things to come from size and regulated industries!

As a result, with the pills, I have some days when I can get by with only two 5-325 tabs a day- where I was at eight 10-325s a day for a long time, and had to fight to get down to even 6 5-325s with a massive drop in quality of life. Other days, I'm back up to six. I just want some sort of solution that doesn't keep me on the hard drugs constantly, some way to live as something other than a wounded animal for the majority of my life, to not hang on to a theoretically easy job by crackling fingernails... and then this sort of nonsense gets the press and makes all sorts of vaporware promises! I'd cry if my eyes weren't dry already.

Sigh. To make matters worse, to get the medical discount (my insurance, for obvious reasons, won't pay for the pot), I have to GO to a naturopath. He's the only one who will write them, and while he seemed nice at first, Jesus did he get pushy about the woo. Even some of the stuff with some scientific basis, like B-12, he just would not believe that my wife and I found a compound sublingual pill that could POSSIBLY equal his injection. And he pushed "healing hands" nonsense, and ugghhhh.

I don't know how good pot actually is for me. My anecdotes don't plural to data, and the fibro alone has always had a viciously unpredictable cycle. I just wish we could get research into something like that, without the hype, without the claims that it's panacea, and maybe get some structured, organized, scientific delivery.

And maybe one day I wouldn't hurt so much or be tired all the damn time.

The foremost defender of quacks is concerned that doctors won't be able to get CME credit for studying quackery any more

oracknows — Mon, 27 Mar 2017 01:29:30 +0000

The foremost defender of quacks is concerned that doctors won't be able to get CME credit for studying quackery any more

Although the requirements vary from state to state, all states require that physicians obtain a certain number of CME credits every licensure period in order to renew their medical licenses. Also, although again the specific requirements vary by specialty board, in order to retain board certification physicians and surgeons must meet certain specific CME credit requirements. Indeed, a particularly annoying new requirement is that a certain number of these credits be "MOC" credits, where MOC stands for "maintenance of certification," a particularly contentious topic among physicians. Basically, in surgery at least, an MOC credit means that the CME activity has to have a post-test of some sort that the participant must pass in order to claim the credits. The American Board of Surgery, for example, requires, in addition to the usual CME requirements, 60 of these "higher level" credits every three years, to be documented—you guessed it—every three years. Personally, I find these sorts of credits to be a major pain and not particularly helpful when it comes to actually learning what the CME activity is supposed to be teaching, but that's just me. However it's done though, the processes by which CMEs courses are accredited is a big deal in the world of medicine.

The number one defender of quacks perceives a threat

The reason I started out with a little primer on CME credits is because there is a form of CME that I very much don't like. I bet that you can probably guess what it is. Did you know that doctors can receive CME credits for studying pseudoscience and quackery as though they were medicine? Regular readers won't be surprised. After all, if we physicians have to imbibe a certain number of CME credits in order to maintain our medical licensure and specialty board certification, we'd like the information that we're expected to be exposed to and learn to be high quality, science-based information, preferably recent updates in our specialties, so that chasing CMEs isn't just a chore but a way that actually helps us to practice according to the latest science- and evidence-based standards. It's the minimum that our patients deserve.

What got me started on this topic was a post by someone we've met before, a post from the "other side." The man writing the post is Richard Jaffe. You might remember him as the longtime attorney for a man who has been a frequent topic of this blog, Dr. Stanislaw Burzynski, the Polish expat physician based in Houston who has been administering peptides he calls "antineoplastons" (ANPs) to cancer patients for four decades now, with authorities seemingly unable to stop him. Jaffe might well have ceased to be Burzynski's attorney last year, thanks to a falling out based (apparently) on Burzynski's failure to pay his legal bills accrued during his defense against the Texas Medical Board. (Unfortunately, Burzynski got off lightly yet again, even without Jaffe shepherding his defense across the finish line.) Their falling out aside, over more than two decades, Jaffe defended Burzynski from all threats, be they from the FDA or the Texas Medical Board. Indeed, he was the architect of a scheme that allowed Burzynski to set up over 70 dubious clinical trials of ANPs, a strategy he's been milking for 20 years to continue to administer ANPs without being prosecuted, despite ANPs lacking FDA approval. Even though he and Burzynski appear to have parted ways, though, Jaffe is still very much into defending quackery, as is easily verified by a perusal of his blog. Oh, and he's pro-"vaccine freedom"—cough, cough, antivaccine—too.

Right now, Jaffe is not pleased, and if he's not pleased that means I probably should be pleased. He expresses his displeasure in a post entitled "The next big CAM battle is here, and it's ugly." Guess what the battle is about?

CME:

CAM or integrative medicine doctors have had their problems with the state medical boards. And CAM organizations have had their run-ins with governmental agencies. However, the groups have always survived in large part because they have had a steady income from membership dues and from their annual conferences, where their members learn the latest and greatest from their thought leaders. But the CAM organizations’ income stream is now in jeopardy, and thus so is their existence, based on what looks to be well-planned, systematic effort to put CAM groups out of business, and stop the dissemination information about CAM therapies.

AND THAT MY FRIENDS IS A VERY BIG DEAL.

I can't help but wonder if Jaffe really wanted to start his post that way. Think about it. He's just basically admitted that CAM organizations exist on membership dues and by hawking their conferences as a source of CME. But wait, you say, isn't that what all professional societies in medicine do? Yes, but that's usually not all, and the big difference is that legitimate professional societies don't peddle pseudoscience. CAM (complementary and alternative medicine) organizations do. Being able to offer CME provides a patina of legitimacy, too, because the organizations that offer CMEs have to meet standards laid down by the Accreditation Council for Continuing Medical Education (ACCME). The AMA, which certifies a large proportion of the CME credit programs in the US, requires that the activity meet all the requirements by either the ACCME or a recognized state medical society (SMS).

So what is this horrific threat to CAM or "integrative medicine" (IM) CME? Jaffe is more than happy to tell us:

For months, at least two CAM groups have been under review/ investigation by the primary private CME accrediting company, the ACCME (Accreditation Counsel for Continuing Medical Education). Recently, the ACCME has determined that a significant portion of the groups’ prior year’s CME courses does not meet various ACCME standards. ACCME is demanding that everyone involved in these courses be informed that:

“they were presented invalid information….”

and that the groups:

“instruct them [everyone] to avoid making any clinical decisions for testing and/or treatment based on what was presented, and direct the registrants to accurate and valid sources of information for the problems or systems presented.”

I should point out that this “incorrect” information came from some of the most accomplished, respected and published thought leaders/teachers in the CAM community. These folks have been giving CME courses without incident for decades.

My first thought upon reading this passage was that this is exactly the problem. Physician "thought leaders" in integrating quackery into medicine have been giving CME courses without incident for decades. My second thought was a retort to Mr. Jaffe, "Gee, you say this as though it were a bad thing." My third thought was to wonder which two CAM organizations have run afoul of the ACCME, and how can we as skeptics get the ACCME to look into other CAM organizations running pseudoscientific conferences? After all, we've been complaining about the ACCME accrediting CAM conferences for CME for years, which makes the next passage in Jaffe's little screed music to my ears, if it is indeed true (remember, this is Jaffe who is relating this story):

Further, in terms of future CME courses at their conferences, ACCME has informed these groups – and this is the key to understand what this is all about – that:

“recommendations involving clinical medicine must be based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients and all patient care recommendations must conform to evidence emanating from guidelines and data that meet generally accepted standards of experimental design, data collection, and analysis.”

In short, ACCME is trying to require these groups to only teach mainstream medicine! This is crazy and a huge deal!

I actually half agree here. Yes, this would be a very big deal indeed if the ACCME is actually starting to enforce some scientific rigor on CME conferences seeking its accreditation. No, it would not be "crazy." It would be a long-overdue course correction, something the ACCME should have done at least a decade ago, if not much longer. You don't believe me? Let's take a look at what sorts of "courses" have received certification by the ACCME. Of course, it's not just CAM organizations that get these courses certified. It's some heavy hitters in the world of academic medicine too, an outgrowth of the problem of "quackademic medicine" (the integration of quackery into academic medicine) that has taken root in dozens of medical schools and academic medical centers across North America.

"Quack!" goes the CME course

There are a number of courses and conferences that offer CME credits for learning about "integrative medicine" or CAM. For example, Steve Novella once discussed how physicians can receive CME for acupuncture through Brigham and Women’s Hospital and Harvard Medical School's course on "structural acupuncture," as have others. I can't help but note that the webpage is no longer there, but thankfully the almighty Wayback Machine still has it. Not that it matters that much, because, alas, Harvard is still offering the course. Only this time it's called the The International Structural Acupuncture Course for Physicians: A Palpation Based Approach. Basically, at one of the most respected academic institutions in the world, you can take a course that spans nine months and requires you to come to Boston five times for live "hands-on" teaching about meridians and the latest quackademic studies trying to show that acupuncture "works." Somehow, I bet that they'll forget to mention how it doesn't matter where you stick the needles or even if you stick the needles in because acupuncture is all an elaborate, theatrical placebo.

You can earn a lot of CME credits, too. The Harvard acupuncture course as currently constituted offers 300.25 (why the quarter?) CME credits, of which "182 hours will focus on the theory and science of acupuncture and 118.25 hours will involve live, clinical experience." The course is run by Joseph F. Audette, MD, and an acupuncturist, David Euler, L.Ac., who in previous fliers was described as a "graduate of the Tristate Institute of Traditional Chinese Medicine in New York" and "a recognized authority in utilizing dry needling techniques for the treatment of pain." Mr. Euler is described as a "recognized authority on modern Japanese styles of acupuncture and its integration with traditional Chinese styles and Western medical practice." What amused me is that there is an actual professor of anatomy, Frank Willard, PhD, included in the course faculty, but he is not Harvard faculty. Rather, he is faculty at the College of Osteopathic Medicine, University of New England. Personally, as I did when I discovered that Georgetown University was "integrating" the teaching of acupuncture meridians into its first year anatomy courses, lo, these many years ago, I wonder just what the heck Prof. Willard will say about the anatomy of acupuncture, given that it's based on a prescientific understanding of the human body. Now there's a lecture I'd love to sit in on, if only for the yuks.

It's not just Harvard, and it's not just acupuncture, either, unfortunately. Harriet Hall has lamented how the American Academy of Family Physicians (AAFP) has succumbed to the quackery embedded "integrative medicine" in its CME program. Basically, the AAFP started including various "integrative medicine" modalities in its CME offerings without skepticism or critical thinking.

Then, in my own specialty, there's the Society for Integrative Oncology (SIO)—which really, really, really does not like me—and its annual conference, which this year will be held in Chicago. The schedule and speakers haven't been announced yet, given that the conference is in November, and its overarching goals are the usual CAM pabulum, but we can look at past conferences; e.g., when Dr. Francis Collins was the keynote speaker at the 2011 SIO conference. Let's just say that, in addition to the usual science-based medicine modalities rebranded as somehow "alternative" or "integrative" (e.g., diet, exercise, and lifestyle), there was a whole lot of pseudoscience as well, plus a lot of "spirituality" thrown in, allowing the SIO to be far too generous in its assessment of reiki and other "energy medicine" modalities (or, as I like to call them, faith healing). You can get an idea of the sorts of activities that the SIO allows from "integrative oncology" guidelines for breast cancer that it published two years ago. Let's just say that the science was...weak.

Of course, the SIO objected mightily when I published a perspective article on integrative oncology two and a half years ago. In particular, it objected to devoting so much verbiage to homeopathy in my article, where I used it as an example of how prior plausibility is so important in clinical trials. (Ironically, I expanded the section on homeopathy based on reviewer comments; the original version had a much shorter section on this, The One Quackery To Rule Them All.) "Oh, no," Great Minds in SIO protested. "We know homeopathy is pseudoscience. We are evidence-based! We would never, ever recommend the use of homeopathy, and it was a horrible distortion on your part to imply otherwise." I shut that down with one observation (well, three). First, SIO allows naturopaths in its organization. Second, homeopathy is an integral part of naturopathy. It's required in the curriculum of naturopathy schools and is included on the NPLEX, the test used for licensure in states that license naturopaths. So most, although not all, naturopaths use homeopathy. Finally, one of the authors of the SIO's breast cancer guidelines at the time had a clinical trial of homeopathy registered at ClinicalTrials.gov.

This is the sort of organization that offers CME for CAM conferences.

Mr. Jaffe has a plan

Based on learning that the ACCME might be cracking down on accrediting CME courses and meetings that promote pseudoscience, Mr. Jaffee is afraid:

Beyond these two professional groups, a disease based group has recently been informed that its CME status for future conferences has been rescinded by its CME intermediary. The intermediary denies that it received any pressure or orders from ACCME.

Three CAM groups which have previously received ACCME course certification without any undue problems who in the last few months have had their prior CME course approval rescinded and/or their future CME approval withdrawn or placed in serious doubt.

Is this all a coincidence? Not a chance in hell.

My guess is that more of the same has or is going to happen to other CAM groups.

I certainly hope so. After all, I've seen examples as egregious as the offering of CME credits for a course offered at that quackiest of quacky "autism biomed" quackfests, Autism One. Oddly enough, I would not favor retroactively rescinding CME credit, which would harm physicians who attended courses in good faith, believing they were offering CME credits. However, I would very much favor the ACCME shutting down CME credits for future CAM and integrative medicine conferences teaching pseudoscience like reiki, acupuncture, homeopathy, and the like.

Jaffe is also curious how this horrible (in his mind) state of affairs came about:

Someone out there has to know something or know someone who knows something about how this came about, and who or what group is behind it. (My guess is that ACCME is the vehicle not the originator.)

I think there is a smoking gun out there, and if we find it, we can probably reverse ACCME’s decision quickly, so my suggestion is that all the CAM groups and interested parties get the word out to search for the smoking gun.

How much does anyone want to bet against my prediction that in a future post he announces that he's discovered that big pharma or the FDA was behind this move on the ACCME? Yeah, you're probably wise not to take that bet.

Not surprisingly, Jaffe's plan is to go straight to state legislators, because state laws generally require ACCME accreditation of CME credits used for state medical licensure:

In all the big CAM states like Texas and California, I know there are legislators who are pro CAM. My suggestion would be to identify who they are (not hard in Texas). I think the boards in a few of these states need to hear from some legislators about how ACCME is undercutting board rules (in Texas) or the CAM statutes (like in California).

These legislators should copy ACCME on their concerns expressed to the boards. If one of them is on a legislative health committee, even better. Better still would be for a couple states to start an investigation on ACCME’s motives. Maybe even an invitation to appear at a specially called hearing. Legislators can hold hearings for all kinds of reasons. So can federal legislators. I think with all the politically connected CAM docs out there, mulitipled [sic] by their politically connected patients, well I think there’s a heap of trouble that could be stirred up for ACCME.

It doesn’t have to happen in every state, or even many states, just a couple of the big ones. The story is going to get out, and questions are going to be raised. The widespread dissemination of ACCME’s action might even turn-up that smoking gun I mentioned earlier. And once the nefarious motive and scope of the conspiracy publicly surfaces, I think ACCME will be forced to rescind its actions. So, we need to shine some light on these jokers.

Actually, it's the CAM groups who are promoting the teaching of this sort of nonsense who should have some light shined on them.

Still, this is classic Jaffe. It's the very technique he used to strike back in favor of his client Stanislaw Burzynski against the FDA. He'd use his connections, such as to Rep. Joe Barton, who in the 1990s would regularly haul the FDA Commissioner in front of his committee to demand why the FDA was "persecuting" Burzynski. It worked, too. There are a lot of quackery-friendly (or at least sympathetic) legislators out there, particularly in Texas, where appeals to "health freedom" are powerful enough to fuel a resurgent antivaccine movement. Then, of course, California is home to all manner of quacks.

Jaffe's plan might just work.

The real problem

I have no idea what two CAM organizations are the ones running into trouble with the ACCME over their CME offerings, and, to be honest, it doesn't really matter that much. The reason is simple. Jaffe is throwing red meat to his base over a perceived threat that is really not a huge threat at all. Yes, there are CAM groups that hold dubious conferences, and, yes, they are a problem. However, they're not the biggest problem. They are not existential threats to medicine as a science-based discipline.

The most serious threats to medicine as a science-based discipline do not come from most CAM groups. Rather, they come from within medical academia itself. Do you think that Harvard had any trouble getting the ACCME to accredit its CME offering for its acupuncture course? I highly doubt it did. Similarly, I really doubt that quackademic medicine conferences offered by high profile, respected medical schools and academic medical centers have trouble getting the ACCME to accredit the CMEs for their courses, either. The same thought applies to the AAFP; I'd be surprised if there were any pushback by the ACCME against its inclusion of dubious CAM in its "integrative" offerings. The list of academic medical centers offering dubious CAM courses for CME appears to be growing, as well, with examples like the aforementioned Harvard, the University of Arizona, the University of Florida, The Ohio State University, the University of Michigan, and many more. Add to that the infiltration of CAM into medical school curricula, the infiltration of integrative medicine residencies, and even board certifications, and Jaffe's getting the quacks riled up over a minor issue.

The real problem is not that the ACCME is targeting two CAM organizations, if it's really doing anything of the sort. The problem is that it's not targeting all the universities that offer courses integrating quackery with medicine and that medical academia is embracing CAM in its medical school curricula and residencies, two areas where the ACCME has no authority. The ACME really needs to go much, much farther in enforcing scientific rigor in its CME accreditation process, but, even if it does that, it won't mean much if the LCME (which accredits medical schools) and the ACGME (which accredits residency programs) don't do the same.

oracknows Sun, 03/26/2017 - 21:29

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https://www.youtube.com/watch?v=KtzqvqzBdUQ

This is a most difficult post to make a response.

If I understand your argument, doctors shouldn't teach or learn quackery.

Please clearly and definitively define the term "medical quackery" in less than 150 words so your readers can have further discussion on this very ambiguous subject.

No help from the minions, Orac.

Although let me help with the following:

The term "quackery" is defined as...

the Accreditation Council for Continuing Medical Education (ACCME)

There is a Wile E. Coyote joke in here somewhere.

Did ACCME just fire Mr. Coyote, or did they just realized that Mr. Coyote is the negotiator for a bunch of CAM groups? Either one of those would work.

How odd ... there's a Michael J. Dochniak listed in the Encyclopedia of American Loons. Can it be?

MJD, you have been around this blog long enough to know what medical quackery or quackery are as defined by Orac. There is no need for him to lower himself to your level to answer your inane questions.

Real medical professionals need to learn more real medical processes and information. If you are a CAM pretender learning how to read nose hairs to determine IQ maybe of some value ($$$$).

@ Orac,

This is exactly why I didn't want you to rely on the minions for a definition of "medical quackery".

Comment (#2) uses the fictional cartoon character Wile E. Coyote to dish-out respectful insolence.

Comment (#3) uses the word "Loons" to dish-out respectful insolence.

Comment (#4) bravely tries to shield you from attempting a definition of the term "medical quackery".

Be respectful and accountable to your readers, clearly and definitively define the term “medical quackery” in less than 150 words.

MJD, your reading comprehension must be low. I did not attempt to shield Orac from trying define quackery in a 150 words or less. I simply stated that if you have actually been reading this blog you would know Orac's definition of quackery.

In no way would I try to prevent or shield Orac from responding to your request. Hopefully if Orac does respond it is with less than respectful insolence.

The problem with licensing is it tends to reduce innovation and progress by reducing competition. The professional monopoly becomes the only judge of its own excellence. And even, as illustrated here, tries to force professionals within its own ranks to stick with the status quo to protect entrenched interests. In essence, it's a medical mafia, protecting its own interests under the guise of protecting the public--doing everything in its power to stop the rising tide of market demand for alternatives to the allopathic model.

Shiiiiiiiiiiiiiiit -Only a loon would think that our host would need the assembled minions to shield him from wit of MJD.

Of course MJD knows exactly what quackery means. Once our host responds, MJD can cry that he can't engage because he's in moderation, so he should be set free to post his silly ideas.

NWO Reporter has hit the nail on the noggin once again. Why should professional organizations have a monopoly on licensing and certifying individuals?

I should be able to design a bridge or fly a commercial jet without those silly requirements that are intended solely as economic protectionism. And we should all have the power to challenge the Medical Mafia by setting up oncology clinics in our garages.

I have every confidence that our new Administration will find a way to let the market decide these matters.

The professional monopoly becomes the only judge of its own excellence. And even, as illustrated here, tries to force professionals within its own ranks to stick with the status quo to protect entrenched interests.

So I take it that you believe that The American Institute of Aeronautics and Astronautics should host a conference and allow speakers from the Flying Carpet industry?

I'm saying that the public has discerned, with good reason, that the medical monopoly is not quite as excellent as it proclaims itself to be. :)

NWO Troll: " with good no reason,"

Fixed it for you.

Seems to me that there are plenty of quacks who operate outside of their "professional" organizations.

The problems are that groups like the AMA are too stringent, its that they aren't stringent enough in dealing with quack operators....and heck, it has also been pointed out here, multiple times, that medical boards don't do enough to punish bad doctors.

Old news, once again. Don't you have another video to produce?

I’m saying that the public has discerned, with good reason, that the medical monopoly is not quite as excellent as it proclaims itself to be.

Citation, please, that any more than a smattering of loons and idiots believe that the "medical monopoly" doesn't embrace enough quackery.

Surgeons are skilled with their fingers. I'm sure our host will have little difficulty raising the appropriate one in response to the question posed - or rather the poser/poseur.

NWRO, you are confusing licensing with Continuing Education to maintain said license.

Probably in the next several weeks I will be having a fusion surgery performed on my C-5/6 disc. Now should I go to a general surgeon or should I go to a neurosurgeon. Of course you select a neurosurgeon.

In todays age you can check credentials, training and any enforcement action of a medical provider very easily. Would you use a medical provider that is not current in their field for whatever you are having done? I think not. If my neurosurgeon had just taken CME concerning the use of balsa wood in place of cadaver bone for the fusion, I would be running away screaming killer rabbit.

The problems are that groups like the AMA are too stringent, its that they aren’t stringent enough in dealing with quack operators….and heck, it has also been pointed out here, multiple times, that medical boards don’t do enough to punish bad doctors.

Case in point: Dr. Jay Gordon, who is allowed to add the otherwise unfortunate acronym FAAP after his name.

Serious question, since I'm not in the medical business: How does one become a fellow of something like the AAP? Can any member claim that title? Is it a higher tier of membership (akin to Patron or Sponsor in certain other organizations) that comes with an additional membership fee? Or is it like the scientific societies I am familiar with, in which one has to do more than open the checkbook to become a fellow? I know some people who have earned the title Fellow in my primary scientific society--they are among the best-regarded people in the field, which is why they have been chosen for that honor.

Linus Pauling said:

Everyone should know that most cancer research is largely a fraud, and that the major cancer research organisations are derelict in their duties to the people who support them.

I’m saying that the public has discerned, with good reason, that the medical monopoly is not quite as excellent as it proclaims itself to be.

Like general relativity, amirite?

Well, special relativity has had it's critics.

In essence, it’s a medical mafia, protecting its own interests under the guise of protecting the public–doing everything in its power to stop the rising tide of market demand for alternatives to the allopathic model.

There is exactly one "alternative to the allopathic model," and that is the homeopathic "model." Do try to better familiarize yourself with that whole "semantics" thing, as you've been performing very poorly overall.

Probably in the next several weeks I will be having a fusion surgery performed on my C-5/6 disc. Now should I go to a general surgeon or should I go to a neurosurgeon.

Go to Orac and get a man-boob reduction in the process.

I thought the converse of allopath was naturopath?

This Chris appears to be the odious Travis J. Schwochert né Fucklesworth

Yeah, it's him. Rather interesting. He's impersonating someone who only ever commented once on this blog ever—in 2009.

He's gone now again—for now.

Go to Orac and get a man-boob reduction in the process.

Well, now we know that we don't have a new Chris, but it's just another Travis J. Schwochert f 239 S Church St Endeavor, WI sock puppet, as noted in http://lizditz.typepad.com/i_speak_of_dreams/2017/02/the-fendlesworth-m…

No disrespect to Orac but I don't think I would want him (other than in an emergency) messing with my c-spine.

Wow, other Chris. First a quote from someone who died over twenty years ago, and a fifty year old paper. So very timely.

By the way, just because real science and medicine may have some issues, that does not prove alternative methods like acupuncture, homeopathy, acupuncture, and other forms of quackery work. Unlike quackery, real medicine and science actually evolve and change through time.

Travis I know a good vet that can transplant some goat balls in to you. That way you would have at least a minimum set of cojones to use instead of playing with Mr. sock

By the way, just because real science and medicine may have some issues, that does not prove alternative methods like acupuncture, homeopathy, acupuncture, and other forms of quackery work.

I know. We all know those don't work.

I am all for molecular treatments, but evidence shows that cheap and un-patentable molecules work the best such as: methylglyoxal, bromopyruvate, ascorbate, and curcumin.

And the avoidance (or admittance as such) of carcinogens like dairy, fluoride, and diagnostic radiation.

...the rising tide of market demand for alternatives to the allopathic model.

So you think that just because there's a huge demand for painless and risk-free relief from ailments, quacks should be allowed to offer treatments that are proven to do nothing beyond placebo, yet claim effectiveness?
Then you must be quite a fan of this old Latin adage: "Mundus vult decipi, ergo decipiatur"

Chris @28 " the avoidance (or admittance as such) of carcinogens like dairy"
Dude.
Dairy?

Riddle me this: if dairy is so bad for you then why did the mutation to retain the ability to digest lactose beyond infancy arise 3 separate times?

Wow, other Chris is staggering! Hello, Travis, from America's Dairyland.

In addition to being a sock puppet troll, do you also engage in cow tipping?

The latest "Chris" is almost certainly Travis J. (for Jerk) Schwochert. The hammer has be summoned.

F@ck off travis.

I thought part of the point of being a sock puppet was to *hide* the puppetry. That doesn't work when you answer a question as another person.

Also, your first citation says that the evidence for dairy as a carcinogen is controversial and contradictory.

Mooooving on.

Bother, my 'nym didn't enter properly and I'm off to moderation.

Carmine or Travis go read about how dairy operations actual work and when cows are actually milked.

So now you've moved the goal posts from "dairy" to "milk from pregnant cows".
What about other forms of dairy? Goats? Sheep? Water buffalo? Camel? Horse? Yak?
Human?

Cows are not kept continuously pregnant and almost all milk production is after birth of the calf. The reason that veal is available is that most dairy calves are removed from the mother so her production can go to us.

I think I know a little bit about the causes of prostate cancer since I am so far a survivor of stage 3 prostate cancer.

JustaTech, I don't doubt this Carmine person would enter a wild bull milking contest. The knowledge base of dairy operations isn't there.

Latest Travis sock puppet: "Dairy cows are constantly kept pregnant so they can produce more milk."

Basic mammal biology fail. Your level of understanding is about the same as the Congress Critter who thought women could "shut things" down to avoid pregnancy from "legitimate rape."

I somewhat wonder whether whatever the ACCME is doing is the equivalent of leaving off the quack miranda: the organizations that got in trouble were talking about real medicine, and doing it wrong, as opposed to talking about homeopathics or whatever.

the Congress Critter who thought women could “shut things” down to avoid pregnancy from “legitimate rape.”

Wow, other Chris. First a quote from someone who died over twenty years ago

Does anyone have a source for the purported Linus Pauling quote?

I was going to save Travis Schwochert's comment but I see Johnny did it already, linking Travis to it. Don't see how that comment is "defending yourself" Travis. Spare us the nonsense Travis Schwochert; you're just a garden-variety scumbag.

doing everything in its power to stop the rising tide of market demand for alternatives to the allopathic model

There's also a rising tide of market demand for fentanyl. Let freedom ring!

herr doktor:

https://paulingblog.wordpress.com/2008/10/28/clarifying-three-widesprea…

This article from a pro-Pauling blog is doubtful about the veracity of this quote. They were unable to identify a reliable source despite what appears to be a thorough search. They also present a case that such a quote would be uncharacteristic of Pauling.

In any case, Linus Pauling, in his dotage, fell victim to Nobel disease, his being perhaps the most prominent case. Very sad.

Rich Bly: "Carmine or Travis go read about how dairy operations actual work and when cows are actually milked."

I have actually visited dairy farms, where much of this stuff is explained. Yes, they spray some of the manure on the fields they grow for winter siliage. They call the smell the "smell of money." ;-) It is also the reason we decided to not stay in the hotel in Tillamook, but move to another Oregon coast town (yes, it was central to places we wanted to visit, but it does turn out they are very serious about the several small dairy farms where they source the milk for their products).

But I also have more personal experience than Travis in milk production. I sincerely doubt Travis has given birth and breastfed three children. Total years in lactation was a bit more than five years.

@TBruce, #47

There’s also a rising tide of market demand for fentanyl. Let freedom ring!

Your comparison is somewhat flawed: fentanyl actually works. Quackery doesn't. Yet somehow, that doesn't stop NWO Reporter from advocating it.
Besides, his argument is also flawed in another way: the market for quackery isn't really demand-driven, it is supply-driven. Yes, there is a universal demand for easy, painless and non-invasive cures, but the demand for all sorts of quackery stems from the fact that actual people can and will offer such 'cures' with impunity, regardless of the fact that they don' t work. As often said before, it is nothing short of a legitimate scam, and with the most precious thing we have at that -- our health.
And since most people have insufficient medical/scientific knowledge to independently judge the validity of health claims, it is important that they are protected from these con artists. This protection is basically simple: all treatments offered should have scientifically proven effectiveness.

@Richard #51, I think your sarcasm detector is broken.

@Julian Frost. #52

I think your sarcasm detector is broken.

Hehe, no, I get TBruce's point -- it was just an opportunity for me to contrast the ineffectiveness of quackery to something that actually works (even if it hints towards illegal use of a potent drug).

Hi Richard,

Yeah, but the problem with fentanyl is the stuff being used to cut heroin is not legally produced. Criminals produce it and import it from Mexico or China.

I get the point you're trying to make, but it distracts from TBruce's point: that just because something works, doesn't mean everybody should be using it willy nilly.

"“Carmine or Travis go read about how dairy operations actual work"

You don't want him to get excited.

Hallelujah! The mainstream press finally notices quackademic medicine!

oracknows — Wed, 08 Mar 2017 05:00:41 +0000

Hallelujah! The mainstream press finally notices quackademic medicine!

I've been writing about a phenomenon that I like to refer to as "quackademic medicine," defined as the infiltration into academic medical centers and medical school of unscientific and pseudoscientific treatment modalities that are unproven or disproven. I didn't coin the term. To the best of my knowledge, Dr. Robert W. Donnell did nine years ago. However, I adopted it with a vengeance, so much so that a lot of people think I coined the term. In any case, I first began sounding the alarm about the infiltration of quackery like acupuncture, "energy medicine," naturopathy, homeopathy, chiropractic, and others from near the very beginning, but I didn't really start warning about it in a big way until the first iteration of my Academic Woo Aggregator, which listed all the academic centers that I could find at the time, what "complementary and alternative medicine" (i.e., CAM, or "complementing" medicine with quackery) modalities. I counted 45 at the time. Within less than a year I gave up trying to keep the Woo Aggregator up to date, because there was just too much. Depressing, I know.

By the time I wrote my (in)famous article for Nature Reviews Cancer on "integrative oncology" in 2014, I counted a high proportion of National Cancer Institute-Comprehensive Cancer Centers were either affiliated with academic medical centers into quackademic medicine or had "integrative medicine" themselves. (Remember, CAM morphed into "integrative medicine," which is represented as the "best of both worlds" but in reality is the "integration" of quackery with real medicine.) By the time I gave a talk on integrative medicine last fall, I counted well over 60 North American institutions, many of them highly respected, offering quackery. It is this development that I've been doing my small part to combat for over a decade now and that Science-Based Medicine has been combatting for nine years. It seemed like a long, lonely batte. Many people didn't believe us, and many physicians are "shruggies" in that they realize that modalities like acupuncture and naturopathy are quackery but don't care enough to speak out against it. Sometimes it takes rubbing their nose in it by showing them what is really said in integrative medical centers to get a reaction. I was particularly amused by the reaction of Dr. Toby Cosgrove, CEO of the Cleveland Clinic was shocked—shocked!—to find out that the director of his Wellness Institute, Dr. Daniel Neides, had antivaccine tendencies, as evidenced by an op-ed that he wrote. That's what happens when you allow pseudoscience to take hold at an institution like the Cleveland Clinic, and, make no mistake, quackademic medicine reigns supreme there.

Interestingly enough, Toby Cosgrove features in an article that I've been waiting to see in a mainstream publication ever since I've been at this, in this case STAT News, where yesterday was published an article entitled Medicine with a side of mysticism: Top hospitals promote unproven therapies by Casey Ross, Max Blau, and Kate Sheridan. Basically, it's the highest profile article I've yet seen on quackademic medicine. True, it's not the New York Times, but it'll definitely do. The reporters do a very good job cataloguing the quackery being promoted by 15 major academic medical centers with little or no evidence to support it.

My only complaint is that I wish it could have been more comprehensive. There's a lot more quackery in academic medical centers than even Ross, Blau, and Sheridan realize. A lot more. Believe me, I've been at this for years, and I know. My other minor nit pick is that the list of alternative therapies offered by these medical centers doesn't strikes me as missing some things. For example, I know the University of Michigan offers more than just acupuncture. The co-director of the Integrative Medicine Program is a friggin' naturopath, fer cryin' out loud! Given that naturopathy is a cornucopia of quackery ranging from homeopathy to traditional Chinese medicine to many, many others, I find it hard to believe that the Integrative Medicine Program only offers acupuncture, particularly given that U. of M. offers an integrative medicine fellowship. And don't even get me started on the anthroposophic medicine offered at U. of M., as I've already ranted about it. Let's just put it this way. It doesn't get much quackier than anthroposophic medicine. (Cough! Cough! Rudolf Steiner!) Also, U. of M. studies acupuncture, nutrition, herbal medicine, spirituality, mind-body therapies, and energy medicine. They have to offer such treatments in order to be able to study them.

I don't mean to be too hard on the reporters. This is a far better article than I've seen in a major mainstream media source. Usually, I'm seeing people like Nancy Snyderman doing credulous pieces in which she waxes poetic about how awesome integrative medicine is and how all hospitals should be offering it. I hope they'll just consider it constructive criticism, hopefully for next time.

I can't resist getting into the good stuff of the article by starting in the middle, given my mention of Dr. Cosgrove:

Asked about the Cleveland Clinic’s promotion of reiki, Dr. Richard Lang, the recently named interim director of the clinic’s Wellness Institute, said he hadn’t had a chance to think about it. “I don’t know that I could give you a plus or minus on that,” he said. Lang served as a vice chair of the wellness institute for nearly a decade before taking the top post.

Notice something? Dr. Daniel Neides is no longer the director of the Wellness Institute. Cosgrove actually fired him! Funny how it only came out in this article in passing, and that only someone who had paid attention to the story. In any case, I've mocked the reiki pamphlet that the Cleveland Clinic has on its website and how it describes channeling "healing energy" from the "universal source." It basically accepts the quackery that is reiki, which is basically faith healing that substitutes Eastern mysticism for Christian belief, as real. (There's a reason the Catholic Church doesn't like reiki in its hospitals; it recognizes another religion when it sees one.) Guess what? It's still there on the Cleveland Clinic website! Apparently the Cleveland Clinic is still offering it for cancer, infertility, Parkinson's disease, chronic pain, and more. If there's one thing this article is good at, it's letting advocates of quackademic medicine hang themselves with their own words, such as here, where STAT notes how he disavowed the antivaccine article in January. They cite Dr. Cosgrove's doubling down on quackademic medicine in the wake of Dr. Neides' article.

I also like how shining the light on the embrace of "energy medicine" by many of these academic medical centers makes their leadership very uncomfortable—as well it should:

MedStar Georgetown quietly edited its website, citing changes to its clinical offerings, after a reporter asked why it listed the energy healing practice of reiki as a therapy for blood cancer. Cleveland Clinic struggled to find anyone on its staff to defend the hospital’s energy medicine program, ultimately issuing a statement that it’s “responding to the needs of our patients and patient demand.”

And the director of an alternative medicine program at another prestigious hospital declined to speak on the record — out of fear, he said, that his remarks would be construed as “fake news” and stir a backlash.

The rise of alternative therapies has sparked tension in some hospitals, with doctors openly accusing their peers of peddling snake oil and undermining the credibility of their institutions.

Good. But my reaction to that bit about "fake news"? WTF? Is this the new excuse spokespeople are going to use to get out of answering questions that they don't want to answer? Be that as it may, I would quibble here, too, but not so much because the reporters got it wrong. They didn't. I realize that I'm not a reporter. One huge difference between a reporter and me is that I can editorialize to my heart's content. It's what I do here. They cannot. From my perspective, the problem is not that the rise of alternative therapies at academic medical centers has caused tension and backlashes. The problem is that the rise of alternative medicine at prestigious academic medical centers hasn't provoked nearly as intense and prolonged a backlash as it should, because these "integrative medicine" programs are selling snake oil under the name of prestigious medical schools, such as Yale, Harvard, Stanford, and many others. Physicians who practice science-based medicine should be up in arms at the first sign of this quackery entering their hospitals, but, alas, the vast majority of them are shruggies. In a way, I can understand it. What do docs who speak out against quackery medicine get in return for their trouble? Well, Steve Novella was sued. I've been the target of a ten month campaign of online defamation by Mike Adams. Before that, I've had people complain to my state medical board for my online activities, and antivaccine activists tried to get me fired from my job. I'm not alone, either. Standing up for science makes waves, and waves make trouble.

One very important point is driven home in this article. Several quackademic docs are quoted defending their practice by saying that alternative medicine is never offered without conventional medicine, dropping meaningless platitudes that will be familiar to readers of this blog like:

“Here at UF [University of Florida], we do not have alternative medicine. We do not have complementary medicine. We have integrative medicine,” said Dr. Irene Estores, medical director of the integrative medicine program at the University of Florida Shands Hospital in Gainesville, Fla.

Ugh. Double ugh. Has there been a more smarmy, more disingenuous defense of "integrative medicine." My response is: Bullshit. You "integrate" alternative medicine with medicine. Also, as they say, integrating cow pie with apple pie doesn't make the cow pie better; it makes the apple pie worse. That's exactly what's happening at UF and all these programs.

It's also not true in a lot of cases that these universities don't ever promote or use alternative medicine other than with real medicine. I've pointed this out myself. Rather, there's money to be made, and these quackademic medicine centers are going after it. I've already discussed how the Cleveland Clinic was selling a homeopathic detox kit on its website. Unfortunately, the Clinic is not alone:

But while those cautions may come through in the clinic, the hospitals also promote alternative medicine online — often, without any nuance.

Duke’s Integrative Medicine store, for instance, sells “Po Chai Pills” that are touted on the hospital’s website as a cure for everything from belching to hangovers to headaches. The site explains that taking a pill “harmonizes the stomach, stems counterflow ascent of stomach qi, dispels damp, dispels pathogenic factors, subdues yang, relieves pain.” None of that makes sense in modern biomedical terms.

Thomas Jefferson University Hospital’s website touts homeopathic bee venom as useful to relieve symptoms for arthritis, nerve pain, and other conditions. The site does tell patients that the biological mechanism for the treatment is “unexplained” but asserts that studies “have been published in medical journals showing homeopathic medicines may provide clinical benefit.”

You know, there was a time, early on, when I would be shocked at finding an academic medical center using or selling homeopathy. Indeed, early on in the history of my Academic Woo Aggregator, I would call sites "super woo sites" if they offered reiki or homeopathy. Obviously, it's because reiki is faith healing, and homeopathy is what I like to call The One Quackery To Rule Them All. These days, practically all of them offer reiki, and a disturbing number of them offer homeopathy. Granted, in the case of homeopathy it might not be obvious that that's what's being offered. Just think of it this way. Naturopathy is infiltrating medical schools and organizations like the Society for Integrative Oncology, and, wherever you find naturopaths, there's a very good chance you'll find homeopathy, because you can't have naturopathy without homeopathy. Homeopathy is a big part of naturopathic training. Indeed, I bet there are more than two of the fifteen hospitals offering homeopathy under the guise of naturopathy.

So how does TJUH defend offering homeopathy? Prepare to groan:

Asked about the therapy, Dr. Daniel Monti, who directs the integrative health center, acknowledged that the data is “largely anecdotal,” and said the hospital offers the treatment only rarely, “when there are few other options.” But those caveats don’t come through on the website.

In other words, there's no compelling evidence, but Dr. Monti offers it anyway. Meanwhile, another director of another integrative medical program, this one at Duke, opines:

The counterargument: Modern medicine clearly can’t cure everyone. It fails a great many patients. So why not encourage them to try an ancient Indian remedy or a spiritual healing technique that’s unlikely to cause harm — and may provide some relief, if only from the placebo effect?

“Yes, as scientists, we want to be rigid. But me, as a physician, I want to find what’s best for a patient. Who am I to say that’s hogwash?” said Dr. Linda Lee.

"Who am I to say that's hogwash?" You're a friggin' DOCTOR, that's who! It's your job to tell patients when a treatment is hogwash and to try to guide them to science- and evidence-based treatments. But how do you determine what's hogwash and what's not? Hmmmm. If only there were a method to figure out what's best for a patient. What would that method be...? I wonder... Oh, yes!

Science.

Also, the "appeal to the placebo" is a tired old trope. For one thing, invoking placebo effects requires lying to patients. For another thing, because, as larger, more rigorous clinical trials of alternative medicine modalities fail to find benefit above and beyond placebo, increasingly apologists for integrative medicine are increasingly falling back on the claim that placebo effects can heal. Note the double standard here. No pharmaceutical or device would ever be approved by the FDA if its manufacturer were to acknowledge that it does no better than placebo and to fall back on attributing whatever perceived benefits it has to placebo effects. Yet that is exactly the standard of evidence that defenders of "ancient Indian remedies or a spiritual healing technique" want you to accept for their woo. The bottom line is that placebos don't heal, and thinking doesn't make it so. Indeed, I argue that integrative medicine is the resurrection of medical paternalism, in which the doctor knows best and can even lie to the patient if he thinks it in the patient's best interest. This is, of course, in marked contrast to the "patient-centered" care and "empowering" image that integrative medicine practitioners like to portray.

If there's one area where the reporters were a bit too credulous, it was on acupuncture. This is common. A lot of doctors are too credulous about it too. That does not excuse this howler:

And while the evidence of its [acupuncture's] efficacy is not ironclad, neither is the evidence for various pharmaceutical therapies that are routinely provided by hospitals and covered by insurance. Some of those solutions, such as opioids to treat pain, have resulted in addiction and harm to patients.

Can you say "false equivalence"? Sure, I knew you could. Sorry, guys. You were doing so well, but that won't stop me from being a little...Insolent...when I see something that makes me cringe when I read it. Acupuncture is a theatrical placebo, nothing more. In contrast, we know how opioids work, as well as the risks and benefits. Again, if you haven't been following these issues for years and aren't familiar with the corruption of language that integrative medicine has engendered, it's very, very easy to accept explanations like this one:

They note, too, that traditional doctors sometimes stray from proven treatments, for instance when they prescribe medicines off-label for conditions the drugs have not been approved to treat.

“We do use things that aren’t necessarily 100 percent evidence-based, but I would argue that’s also true within all of medicine,” said Dr. Jill Schneiderhan, co-director of the University of Michigan’s integrative family medicine program. “I feel like it’s not black and white.”

No, medicine is not black and white. It's never been black and white. Interpreting scientific evidence to apply it to individual patients is especially not black and white. Yes, sometimes we use treatments on patients that aren't entirely evidence-based, but that's because there are factors other than science that impact treatment, such as patient desires and values. Leaving that aside, there's the difference. For most medical treatments, there is science behind it that produces scientific plausibility. In contrast, for much of alternative medicine, there is little or no scientific plausibility. Homeopathy, for instance, in which remedies are diluted to the point where there is unlikely to be a single molecule left, has about as close to zero plausibility as can be imagined. Ditto "energy healing," which is based on mysticism, not science. When there is little or no scientific plausibility, what you end up seeing in clinical trials are noise and bias, not a real signal. Yet, integrative medicine routinely mistakes that noise and bias for a signal.

Sadly, as this article shows, it's popular too. Nearly all the directors of integrative medicine programs interviewed reported that their patient volume has been growing. It just goes to show that many academic medical centers are more than willing to sell snake oil to attract patients. This is what skeptics are up against.

Worse, depressingly, it's not getting better. Remember how I said that this was the first article in a major mainstream news media outlet that was close to as skeptical about integrative medicine as I would like? It turns out that's not true. It's the first one I can remember, but as I was doing searches related to this post, I came across this article from USA Today from 2008 with a very similar headline, Top Hospitals Embrace Alternative Medicine. It's basically the same article, only not as skeptical, with human interest story anecdotes about how alternative medicine helped people. But the overall message is the same: Top medical centers are embracing this. One difference is that it seems to assume there's something to alternative medicine, in contrast to the STAT article, which emphasizes the patient demand and the financial incentive. Either way, the problem is the same. Nine years later, if anything, it's worse.

oracknows Wed, 03/08/2017 - 00:00

Categories

http://scienceblogs.com/insolence/2016/05/16/do-medical-errors-really-k…

Hi.

Perhaps I am relying too much on rumour and TV stories, but I have always had the impression that the USA is the right place to see patients (and heirs) in litigation with healthcare providers.

Is there any story of people feeling defrauded when they seek healthcare and receive reiki, magic water, etc. from a hospital or clinic?

I'm sure that CAM-friendly patients would actually like this, but... the rest of us who need treatment rather than appeasement? is there a scandal waiting to happen?

“Yes, as scientists, we want to be rigid. But me, as a physician, I want to find what’s best for a patient. Who am I to say that’s hogwash?” said Dr. Linda Lee.

Dr. Lee is either FOS or didn't learn a damn thing in med school, residency and fellowship.

Compare what Dr. Lee says to this part of the Hippocratic Oath:

...I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

Quackademic medicine and quackademic physicians like Dr. Lee clearly have no respect or appreciation of those scientific gains.

Asked about the therapy, Dr. Daniel Monti, who directs the integrative health center, acknowledged that the data is “largely anecdotal,” and said the hospital offers the treatment only rarely, “when there are few other options.”........................ My interpretation of that, is; homeopathy is offered as an alternative to at least one appropriate FDA approved med. If that's correct, it's scandalous.

"Who am I to say that’s hogwash?” said Dr. Linda Lee.

Someone who allegedly has basic knowledge of chemistry and physics, that's who you are. And that's all you need to know that homeopathy and reiki are, to use your term, hogwash.

I'll stipulate that some forms of woo are harder to spot--they aren't so implausible on their face, and you actually have to have some detailed knowledge to know why they won't work. But even a layman who has a high school level understanding of chemistry and physics should know that homeopathy and reiki contradict lots of basic science.

Yes, the US is the Capitol of Medical Litigation.

With that said, my impression, which is without evidence, it is just an impression, is that lawsuits against quacks are quite rare. The patients often go to them with a predetermined, positive view of whatever they are going for, and the quacks are quite good at making the patients happy. If the patients are happy, they rarely sue even if the outcome is bad. This is what is really wrong with the tort system. It is almost universally ineffective at enforcing quality except in the most egregious of cases.

I was approached once by a plaintiff's attorney with regard to a form of quackery with which I was unfamiliar. I ended up sending him to Stephen Barrett. I hope he got what he needed from him.

The tort system isn't about enforcing quality. It never was and isn't for that purpose.

The tort system is about damages. It's about getting compensation for a wrong. If you want to improve quality, you have to do that before the wrong occurs, before damages happen.

I review malpractice cases. In almost every case I've reviewed, there either was no causation or fault on the part of the nurse or the facility (or the physician though I don't testify to that one way or the other, naturally) or the fault is so pervasive and systematic to make the case a total train wreck. I'm talking about persistent and systemic issues such as failures to follow/enforce policies and procedures, to utilize good nursing practices, and to document in a consistent and appropriate manner.

It's usually very bad or much ado about nothing, and not much in the middle.

Dr. Finfer is right in that happy patients don't sue. Given the article of faith that believers in woo take, that is the woo treatment failed it was everything's fault but the treatment, this is hardly surprising.

And given that victims of con artists rarely want to report the crime to authorities, it's hardly surprising that the ones who wake up are equally reluctant to sue and show the world what a fool they were made of.

It'll happen eventually. Some family will decide to sue a quack. But it will be hard. The family will have to show the quack violated the law in some way and so much quackery is unregulated. You have to show that the quack's treatment or advice caused the harm, that's going to be very hard to prove under our legal system.

After all, the case against Dr. Burzynski was a slam dunk, wasn't it?

I agree. The cases that I have reviewed are either nothing or unmitigated catastrophes, mostly preventable. There is very little in between. In general, if I feel that I have legitimate questions about a case, I won't take it. I have no interest in wasting my time in battles over stuff like that.

I have also notified a pattern. A case will arrive with the plaintiff's attorney stating that he or she has a theory....

These theories are often outrageous, framed in a way that gives them a chance of producing money, but, if enforced, would create a practice standard that would paralyze any laboratory attempting to do more than a handful of specimens per day. I, of course, will have nothing to do with such cases, and I am finding this to be increasingly annoying. I am sure there are people out there who will take these cases, and I can only describe them as unscrupulous.

Orac writes,

Also, as they say, integrating cow pie with apple pie doesn’t make the cow pie better; it makes the apple pie worse.

MJD says,

Integrating rhubarb pie with strawberry pie, sometimes, makes the rhubarb/strawberry pie better.

Integrating alternative-medicine with science-based medicine, (e.g., patient requested only) may provide a therapeutic synergy.

Finally, I like French's classic yellow mustard on my 100% American beef hot dog even though I know said mustard has no nutritional value.

MJD@9: Do I need to remind you that cow pies are made in cows, not of cows?

The real satire is that the conventional medical system itself is the third leading cause of the death in the US. According to a study by Dr. Starfield of Johns Hopkins, in hospitals alone, this hallowed system causes:

--12,000 deaths/year from unnecessary surgery
--7000 deaths/year from medication errors in hospitals
--20,000 deaths/year from other errors in hospitals
--80,000 deaths/year from infections acquired in hospitals
--106,000 deaths/year from non-error, adverse effects of medications

That totals 225,000 deaths per year from iatrogenic causes. http://www.drug-education.info/documents/iatrogenic.pdf
JAMA 2000 v284(4):483

A more recent study by Johns Hopkins researchers found that the conventional medical system causes over 250,000 iatrogenic deaths per year--and they didn't even include deaths from properly prescribed and administered FDA approved drugs, which considering Dr. Starfield's study, would likely have increased iatrogenic deaths to over 350,000. US BMJ 2016; 353 :i2139

Physician, heal thy own system, and stop worrying about the people who, quite understandably, are seeking out alternatives to your deadly quackery.

"NWO Reporter", since you like to talk the talk, here is a challenge to help you walk the walk:

1. Please never (as in for the rest of your life) see anyone with an MD, DO or NP degree, nor anyone who works in the office of an MD, DO or NP (such as a PA or RN/LPN). Feel free to see all the naturoquacks, chiroquacks, quackupuncturists and reiki scammers you want.
2. Never go to an ER or hospital ever again.
3. Never call 911 ever for help (because, you, know, paramedics work with MDs and DOs).
4. Never use an FDA-approved medication (prescription or OTC) ever again (but feel free to buy sugar water homeopathic solutions all you want)

Please give us yearly updates how you're doing and, after you do die, have your next of kin tell us how you died and how old you were when you died and your cause of death.

Also, you should never drive a car, because some 50,000 people a year die in car accidents.

Also, please don't procreate, because doing so condemns your children to certain death.

@Chris Hickie-- If you come up with any evidence to refute the conclusions in #11, let me know. In the mean time, steer clear of nutritional supplements--they kill more people every year than all the squash blossoms in the world combined! :D

In other quackademic news..

Orac's 'old friend', James Lyons**-Weiler, will be giving a free lecture on the causes of autism based on his Skyhorse book at NYU Law***.
Someone nearby should go. I can't.

** Skyhorse's top honcho is Tony Lyons - coincidence?
*** Mary Holland works there

As a former alt med consumer , i.e. "Recovering chump," I can attest to how difficult it is/ was to make a complaint.
First, I didn't know how, second, I was cheated out of my time money and hope, and I didn't see how a claim would hold up. Third, I had a lot of guilt for making bad choices.4th, my friends still believe in the alt med baloney, and I wasn't ready to let go of them too. So it was much easier to just fade away from those beliefs. It took a very long time to figure out how to still be friends while leaving out the woo. And they still don't think it's woo.woo. It's like, I imagine it would be if all my friends were. Trump believers--it's difficult and it takes time to make new friends.

@MJD #9:

Integrating rhubarb pie with strawberry pie, sometimes, makes the rhubarb/strawberry pie better.

First, demonstrate that your rhubarb isn't actually bullshit.

Go on. Try it.

As a former alt med consumer , i.e. "Recovering chump," I can attest to how difficult it is/ was to make a complaint.
First, I didn't know how, second, I was cheated out of my time money and hope, and I didn't see how a claim against a practitioner would hold up in a legal process.Third, I had a lot of guilt for making bad choices. Fourth, my friends still believe in the alt med baloney, and I wasn't ready to let go of them too. So it was much easier to just fade away from the b.s. rather than confront people.. It took a very long time to figure out how to still be friends while leaving out the woo. And they still don't think it's woo. It's like, I imagine, it would be if all my friends were Trump believers.
It's difficult and it takes time to make new friends when you're ill. I'm not one of the worried well --cancer is a real thing.

This guy is so old....this was already discussed here last year:

It's a valiant effort at damage control, for sure. Maybe if it ever gets published in a peer reviewed medical journal, it could be taken seriously.

Denice Walter writes (~# 14),

...will be giving a free lecture on the causes of autism.

MJD writes,

On a related topic, it's the second time I've been denied to speak at the Annual Autism Society National Conference and Exposition.

This year I submitted a proposal wherein I'd speak on a topic that's both informative and thought provoking (i.e., Autism Patents and Beyond).

@ Oracs minions,

Any suggestions on a topic for next year?

Here's the rejection:

Thank you for submitting a presentation abstract for the 49th Annual Autism Society National Conference and Exposition. Please understand that it is a constant balancing act as we strive to offer a broad-based program covering the whole spectrum and all aspects of the entire lifespan at the conference. Each proposal was given careful and deliberate consideration by a panel of reviewers in addition to our staff. This year was particularly difficult as we received an incredible amount of paper submissions. Regrettably, exceptional proposals are turned away each year for the simple reason that we have limited speaking slots and cover a wide-breadth of topics.

Your proposed abstract entitled “Autism Patents and Beyond” was not selected. But, we would like you to consider allowing the Autism Society to leverage your skills, background and knowledge in the future. There may be other opportunities for you to get involved (e- newsletter articles, blog, web content, Google chats, local trainings/conferences etc.) which may be a good fit for you in the future.

Once again, thank you for your submission, we sincerely hope you will consider engaging with the Autism Society again by submitting an abstract for the 2018 Call for Papers and we would, of course, love to see you at this year’s conference in Milwaukee, July 12 - 15, 2017!

If you have any questions, please feel free to email Rose Jochum, rjochum@autism-society.org

NWO can you come up with the figures of how many times sciencebased medicine had saved these people before they became part of your statistics?

In other quackery news, tomorrow the appeals in the death of Ezekiel Stephan will be heard. Ezekiel died because his parents gave him quack remedies instead of seeking proper medical care. They were convicted of failure to provide the necessaries of life, but were given very short sentences. The Stephans are appealing their conviction and the Crown is appealing the too-short sentences.
Orac wrote about the case a few times.

I may attend the appeal hearing if I can get confirmation it really will go ahead tomorrow (hard to do for anyone outside of "the media"). The hearing will essentially be speeches by the lawyers to a panel of three judges. Since the original trial, Tamara Lovett has been convicted of the more serious charge of criminal negligence causing death in fairly similar circumstances, and the Raditas have been convicted of first degree murder because they did not properly treat their son's diabetes. All of these kids would almost certainly have survived if they had received proper medical care starting a few days before their deaths.

MJD, did you inform her, that you are considered a Loon?

Dear God! You didn't write the application in third person did you?

MJD @9: French's yellow mustard contains 55mg of sodium per 5g (1tsp) serving. It also contains turmeric (likely as a coloring), vinegar and mustard.
Therefore mustard has nutritional value.

Have a balloon.

MJD: What you got wasn't a "denial." It was a rejection.

They happen all the time. There is no conspiracy to prevent you from speaking at this or any other convention. You simply didn't wow them with your proposal.

Starting from a factual basis is usually a good way to get towards wowing a review board.

Asked about the Cleveland Clinic’s promotion of reiki, Dr. Richard Lang, the recently named interim director of the clinic’s Wellness Institute, said he hadn’t had a chance to think about it. “I don’t know that I could give you a plus or minus on that,” he said. Lang served as a vice chair of the wellness institute for nearly a decade before taking the top post

He's been there nearly a decade and never thought about what they offered?

Panacea writes (~#25),

Starting from a factual basis is usually a good way to get towards wowing a review board.

MJD says,

I've been asked by Cambridge Scholars Publishers to submit a proposal for a book on environmental science.

Here's the title:

There's no place like home - Global Warming - Thinking Patents

Please advise...

On a related topic, it’s the second time I’ve been denied to speak at the Annual Autism Society National Conference and Exposition.

Well, that should give you a clue.

This year I submitted a proposal wherein I’d speak on a topic that’s both informative and thought provoking (i.e., Autism Patents and Beyond).

The don't want to give you a free platform to sell your $200 book that is, by your own description, a bunch of copy/paste from the USPTO.

Do the right thing and rent a booth. You'll only have to sell 10 or 12 copies to break even, including hotel and air fare. You'll make a fortune.

Any suggestions ... for next year?

Leave them alone?

Physician, heal thy own system, and stop worrying about the people who, quite understandably, are seeking out alternatives to your deadly quackery.

Nope. How about:
Physician, heal thy own system, because you're appropriate worried about people who – perhaps understandably all things considered, are seeking out alternatives and get duped into useless and sometimes even deadly quackery as a result.

See, it's BS to say hospitals "cause" 225,000 deaths per year. If hospitals failed to prevent 80,000 deaths from infections acquired in hospitalization, that's not 'causing' them. The people who died were in the hospital because they were sick, mostly with conditions which made them especially vulnerable to infection. This is how my mom died. She went into the hospital after suffering injuries in a fall, and being weak and with diminished lung capacity from a history of smoking, after being bedridden for a couple weeks she contracted pneumonia. I was bitter as hell because the doctors should have known she was vulnerable to this, but apparently the 'managed care' of her HMO didn't cover the proper preventative procedure. That's a failure of socio/economic/political forces impacting the administration of healthcare, not a problem of medical science "quackery", and has no relevance in justifying any sort of Alt Med.

Then there's the 106,000 deaths from "non-error, adverse effects of medications", a big-seeming raw number (if accurate) but what's the risk factor compared to the total number of medications prescribed and taken by the population in that year? And, how many of the prescriptions involved in death were really "non-error". If the meds did indeed have "adverse effects" how many of those were the product of inadequate records on contra-indicating conditions or drug interactions? Again, I have personal experiences: my partner's best friend almost died in the hospital earlier this year when – again, after a fall – they didn't know she had a condition that led the iron they were giving her for anemia to cause renal failure, because that somehow hadn't made it onto her chart. Of course, that problem would have been just as likely to occur if she'd been treated by a naturopath. After she turned for the worse, the hospital MDs figured it out, and got her into emergency dialysis before it was too late. I have no confidence an ND would have done the same.

These are IMHO inexcusable failures, but preventing them is a matter of addressing funding and policy issues. Chris Hickie's highway death analogy is only partly accurate. Both driving and going to the hospital haveinherent risks that can't be addressed by improved practices, but the levels of inherent are quite different. Hospital deaths could be drastically reduced by hiring more professional staff to monitor infection risk, and establishing a comprehensive computerized national health record database that would present everything a treating practitioner needs to know on their tablets when they enter the patient's name. In contrast, even if we made the massive expenses of completely rebuilding our road infrastructure for maximum safety, and maintaining the roads in top condition, and banning all gasoline powered vehicles, and mandating state-of-the-art crash safety for every vehicle on the road, we'd still have plenty of fatal crashes as long as people drink or lose concentration. And the resources required to make those changes to driving are orders of magnitude more unlikely to ever be realized than those required to make the changes to hospital medicine I discussed...

Maybe if sbm advocates were more open about the problems in healthcare delivery that undermine the effectiveness of medical science, and more vocal in calling for reform, crap-slinging slimeballs like NWO Reporter would have a harder time propagandizing sCAMs. Speaking of which, I'm wondering when/if Orac will address the likelihood of increased medical tragedy from the GOP backed "replacement" for the ACA...

@ doug

The Stephans were worse than Tamara Lovett and the Radita's because they were trying to protect their DIY-Alt-Med-based family wealth by keeping Ezekiel away from any and all health prrofessionals, and possibly even using him as a guinea pig to generate a testimonial for the 'immune boosting' magic of Truehope OLE. Of course, none of that came out at trial or in the news coverage, and the differing sentences probably reflect the relative defendants' wealth and influence, rather than their actual venality. Lovett is a genuine all-round nut-job/screwup. The Stephan clan's only excuse is snake-oil hard-sell greed.

If NWO Reporter uses the search box on the top of the box she will find our host's analysis of the third leading cause claim and the problems with it.

@ MJD #27:

If they solicited a book from you that tells me all I need to know about their level of academic rigor and prestige.

But to answer your question I have to ask one of my own: how much are they charging you to publish?

Turns out appeal court sitting details are published on the web, and the Stephan case is still sch'd for tomorrow (3 hours allotted time). Guess I better go toss my warm pants in the wash and try to get the blood stains out - going to be about -22°C in the morning.

Sadmar, I think the Raditas are the most despicable, since Alex was tortured to death over a period of years. The Stephans may well have be trying to use Ezekiel for financial gain, but I really doubt any wealth they might have had any influence on their sentences. I suspect their appeal of conviction will be dismissed. Hard to say how the Crown appeal of the sentences will turn out. If Tamara Lovett had been sentenced by now there would be precedent for the appeal court to consider, but she won't be sentenced until June at the earliest. Her conviction for criminal negligence, with a potentially very long prison sentence, may influence the court to consider sentences for the Stephans at or near the upper end of the range for the failure conviction. I don't know if the decision of the appeal court will be delivered tomorrow or at some later date.

According to a CBC article up this morning, only the conviction appeal will be heard today and the court's decision is not expected for some time. The Stephan's are inviting supporters - perhaps I will have the opportunity to growl menacingly at some of them.

Panacea writes (~ #32),

If they solicited a book from you that tells me all I need to know about their level of academic rigor and prestige.

MJD says,

It is disheartening to hear a professor (aka. Panacea) denigrate the academic level of this/any college graduate.

Panacea asks (~ #32),

...how much are they charging you to publish?

MJD says,

It doesn't matter, the information and perspectives described therein contain the true value.

@ Panacea,

It's time to disclose your true identity so I can send a free copy of the book to your university library.

To make sure that you'll be the first one to open the book, I will randomly place three $10 dollar bills in the pages.

A couple of days ago, I got a popup ad from Oregon Health Sciences Unversdity's Pain Clinic. Announcing that it was introducing Rolfing. Notably, it didn't say "pain control", just "pain"!

Given how rough rolfing is, I'd be surprised if it didn't cause pain. :-)

sadmar @29: Have you read The Checklist Manifesto, by Atul Gawande? He advocates for the use of checklists in medicine (specifically in surgical procedures) and he's got some decent data (and I'm sure there's more data by now).

One of the things he specifically wanted a checklist for was to prevent VAP (ventilator associated pneumonia) and I think also central-line infections.

It's a good read.

@MJD: Considering I've already gotten you dead to rights on plagiarism in a past discussion, you wouldn't have a degree from my institution. Regardless, you don't have to have a college degree to publish something through a reputable press, depending on what you're publishing. If you're going to publish something in the sciences, you usually need some credentials.

Your dodge of my question says, "they're charging me too much and I'm embarrassed to say how much."

Keep your thirty dollars. It sounds like you've been fleeced enough.

Re Rolfing: my SIL had it done once for her fibromyalgia.

Once.

Panacea Writes (#39),

Considering I’ve already gotten you dead to rights on plagiarism in a past discussion, you wouldn’t have a degree from my institution.

Michael J. Dochniak says,

Are you calling MJD a cheater?

Impossible, I'm going to tell him the next time I hear from him. :-o

Orac writes,

WTF?

An upset MJD says,

I agree!

MJD: Why, yes. I am calling you a cheater.

The article: "Physicians who practice science-based medicine should be up in arms at the first sign of this quackery entering their hospitals, but, alas, the vast majority of them are shruggies."

Shruggies? I like that word. This is a good noun to describe a an apathetic physician with "woo" lassitude.

Personally, I think "woo" should never be tolerated. It is always immoral to give people false hope. Moreover, it is an insult to science to believe something works without a good indication; homeopathy is the prime example.

I think you should write an article on this Jim Humble affair with chlorine dioxide. He has the audacity to call it "magical mineral solution" although it contains nothing that could properly be classified as a mineral.

This guy seems to have a cult of distributors like that Kalcker guy and that Rivierra girl. Andreas Kalcker's anecdote about his dog recovering spectacularly from a few drops of MMS is painful to hear. I think people could get hurt with this stuff.

I'm sure Orac would have been leading the righteous charge against Dr. Semmelweis, had his blog been around back in the day. After all, Semmelweis's bogus innovation of chlorine hand washing was contrary to the status quo scientific standard of care--he deserved to have his reputation mercilessly smeared and to be run out of the medical industry for the greater good. Meanwhile, the suffering and death continued. Even to this day, apparently--considering that infections acquired in hospitals kill 80,000 people every year in the US alone.

Better that patients be given false hope with the sacred standard of care than to make their own potentially faulty choices. Thank goodness the medical industry is backed by hundreds of billions of dollars now, to keep cranks like Semmelweis in check. http://www.npr.org/sections/health-shots/2015/01/12/375663920/the-docto…

Just because Semmelweis ended up being correct does not mean everyone who bucks the consensus is. As Carl Sagan once wrote:

The fact that some geniuses were laughed at does not imply that all who are laughed at are geniuses. They laughed at Columbus, they laughed at Fulton, they laughed at the Wright brothers. But they also laughed at Bozo the Clown.

Or, as Michael Shermer wrote in Why People Believe Weird Things:

For every Galileo shown the instruments of torture for advocating scientific truth, there are a thousand (or ten thousand) unknowns whose ‘truths’ never pass scientific muster with other scientists. The scientific community cannot be expected to test every fantastic claim that comes along, especially when so many are logically inconsistent.

Or, as I wrote 12 years ago:

For every Galileo, Ignaz Semmelweis, Nicolaus Copernicus, Charles Darwin, Louis Pasteur, etc., whose scientific ideas were either ignored, rejected, or vigorously attacked by the scientific community of his time and then later accepted, there are untold numbers of others whose ideas were either ignored or rejected initially and then were never accepted--and never will be accepted. Why? Because they were wrong! The reason the ideas of Galileo, Semmelweis, Copernicus, Darwin, Pasteur, et al, were ultimately accepted as correct by the scientific community is because they turned out to be correct! Their observations and ideas stood up to repeated observation and scientific experimentation by many scientists in many places over many years. The weight of data supporting their ideas was so overwhelming that eventually even the biggest skeptics could no longer stand. That's the way science works. It may be messy, and it may take longer, occasionally even decades or even longer, than we in the business might like to admit, but eventually in science the truth wins out. In fact, the best way for a scientist to become famous and successful in his or her field is to come up with evidence that strongly challenges established theories and concepts and then weave that evidence into a new theory. Albert Einstein didn't end up in the history books by simply reconfirming and recapitulating Newton's Laws. Semmelweis and Pasteur didn't wind up in the history books by confirming the concept that disease was caused by an "imbalance of humours" (although Semmelweis probably did hurt himself by refusing to publish his results for many years; his data were so compelling that it remains puzzling why he did not do so). I daresay that none of the Nobel Prize winners won that prestigious award by demonstrating something that the scientific establishment already believed. No! They won it by discovering something new and important!

Unfortunately, to most lay people who don't have a strong background in science, the scientific method, or the history of science, such trickery can sound convincing on the surface. For example, you have a quack like Hulda Clark claiming she has a cure for cancer and AIDS and then claiming that the scientific establishment can't accept it. Add a dash of paranoia about big medicine and big pharma "suppressing" her "cure," and it's a potent brew of deception. This ploy is particularly appealing to Americans, because our whole national psyche has in its core a tendency to root for the outsider, the underdog. Alties, pseudoscientists, and cranks tap into that deep-seated sympathy we tend to have for the persecuted outsider and use it to their advantage. It's the same with creationists, who use every well-deserved debunking they get as evidence that they are a "threat" to the established scientific order. The only way to combat such deceptive comparisons is to point out again and again Shermer's dictum that "heresy does not equal correctness" and try to keep the discussion on the hard evidence.

Also, the case of Semmelweis is more complex than quacks generally describe it. Part of the problem is that Semmelweis discovered that requiring practitioners to wash their hands when going from the morgue to the delivery room greatly decreased the incidence of puerperal fever decades before Louis Pasteur demonstrated germ theory to the point where physicians and scientists started to accept it. Thus, part of the reason why Semmelweis encountered so much resistance from his colleagues was because at the time he made his observations, there was no known scientific mechanism to account for his observations. In fact, his observations actually conflicted with the dominant concepts of the time, namely that diseases were due to imbalances of the four humors or caused by miasmas (“bad air”). In fact, it’s not unreasonable to speculate that if germ theory had been developed before Semmelweis, his observations would likely have been rapidly accepted as evidence supporting germ theory.

Also, physicians did not, contrary to the quack narrative, universally reject Semmelweis' findings. For instance, in the UK, the response was much more favorable, and he turned down a position as professor of obstetrics at the University of Zurich, which presumably wouldn't have offered him the position if it were so opposed to his findings. It also didn't help that Semmelweis let his outrage get the better of him to the point where he wrote increasingly angry letters to prominent European obstetricians, even going so far at times to denounce them as irresponsible murderers, comments that surely didn't endear him to the medical community or make it more receptive to his findings. Indeed, it has been suggested that Semmelweis could have had an even greater impact if he had been able to communicate his findings more effectively and to avoid antagonizing the medical establishment so severely, even given the level of opposition from entrenched viewpoints.

It's interesting, although not surprising, that the medical community allowed its anger about Semmelweis's condemnations to override objective scientific judgment.

I think you should write an article on this Jim Humble affair with chlorine dioxide. He has the audacity to call it “magical mineral solution” although it contains nothing that could properly be classified as a mineral.

Try this http://scienceblogs.com/insolence/?s=Jim+Humble

Heheh.

For the clueless boring NWO troll repeating nonsense we have dealt with repeatedly:

Trollin' Trollin' Trollin'
Trollin' Trollin' Trollin'
Trollin' Trollin' Trollin'
Trollin' Trollin' Trollin'
Rawhide!
Trollin' Trollin' Trollin'
Though the threads are swollen
Keep them comments trollin',
Rawhide!

Move 'em on
(Head em' up!)
Head em' up
(Move 'em on!)
Move 'em on
(Head em' up!)
Rawhide!
Cut 'em out
(Paste 'em in!)
Paste'em in
(Cut em' out!)
Cut 'em out
Paste 'em in,
Rawhide!
Keep trollin', trollin', trollin'
Though they're disaprovin'
Keep them comments trollin'',
Rawhide
Don't try to understand 'em
Just rope, laugh, and ignore 'em
Soon we'll be discussin' bright without 'em

Nice diversion from the issue, Chris! That is, if anyone can stifle their yawns long enough to read it. :)

Yawn. You are the one boring us with old rotted baseless arguments we have seen for more than a decade.

Trollin’ Trollin’ Trollin’
Trollin’ Trollin’ Trollin’
Trollin’ Trollin’ Trollin’
Trollin’ Trollin’ Trollin’
Rawhide!
Trollin’ Trollin’ Trollin’
Though the threads are swollen
Keep them comments trollin’,
Rawhide!

Then I'm sure you've been boring people with hypocrisy as a diversion for more than a decade as well. Anyway, truncated and repetitious diversions aren't nearly as effective--so you know.

Snicker. Orac did reply with something he wrote over a decade ago. I told the troll is was old stale nonsense that has been dealt with multiple times.

By the way, there is a vast trove of books about medical history. The most recent one of note is about the doctor that the Mutter Museum in Philadelphia is named after: Dr. Mutter's Marvels: A True Tale of Intrigue and Innovation at the Dawn of Modern Medicine.

The last chapters in that book reveal that Semmelweis was not the only physician who made the connection between sanitation and spread of disease. There were a few others, and some met with similar resistance (including Florence Nightingale, who used actual statistics to become convinced, read https://www.amazon.com/Trick-Treatment-Undeniable-Alternative-Medicine/dp/0393066614/).

It is said that the big difference with Semmelweis was that he was kind of a jerk, so perhaps more people wrote about him. Which is apparently your method of getting noticed. In the future just post the PubMed indexed studies by reputable qualified researchers to support your claims, or just go away. Because repeating the same idiocy over and over and over again is quite boring.

I have an idea, just get off of teh internets, wander down to your local public library and read the above referenced books.

So Semmelweis was "kind of a jerk," and that hindered his ability to persuade others to his position. Have times changed in that regard? Is it now the case that vociferous derision and ridicule is the best way to persuade others to your position? Or is that more of a last resort--when the real weight of the evidence is not on your side?

Granted, there is only so much you can do when the conflicts of interested endemic in medical research have been exposed over and over again, leading to an inevitable loss of all credibility--regardless of how reasonably the conclusions are conveyed, or how expertly someone conveys that anyone who doesn't believe them is stupid.

"It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.” Dr. Marcia Angell, http://www.nybooks.com/articles/archives/2009/jan/15/drug-companies-doc…

Or is that more of a last resort–when the real weight of the evidence is not on your side?

No, it's a last resort when dunderheads like you won't accept the overwhelming scientific evidence that vaccines don't cause all the things you claim they do.

Or "dunderheads" like Dr. Marcia Angell--who has reviewed more medical research in depth over her career than all the "Science Moms" and science bloggers combined?

We saw the quote the first dozen times you posted it. You see, that mindless repetition that you do is what annoys people. It's become very, very tiresome.

Perhaps it was posted among the two comment threads you removed on other posts, since I only see it one other time on this thread. :)

Or "dunderheads" like Dr. Ioannidis, who has found that it's more likely for a research claim to be false than true? Why Most Published Research Findings Are False, http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0…

You might want to search this blog for Ioannidis' name to see what I've written about him (including about that article). You might be surprised what you find. Or not. Suffice to say, I'm a big fan of Ioannidis and have been for at least ten years. Also, that article you cite doesn't mean what you think it does, at least not in terms of reliability of the medical literature overall. Certainly it is foolish to cite it as justification for thinking that vaccines cause autism.

And what of the conclusions of Dr. Marcia Angell? Do they mean what I think they mean? :)

Exactly. Exasperation at someone who perseverates over the same talking points over the course of weeks does sometimes lead to annoyance, and annoyance sometimes does lead to intemperate language. :-)

NWO Troll, you are a dunderhead who cannot figure out how to use the handy dandy search box on the upper right of this page to find the articles that discuss Angell and Ioannidis (several on the latter, he did not say what you think he says). Good grief you are really boring us by bringing up the same old nonsense over and over and over again!

But, Orac, the NWO troll thinks it is to h..a...r...d to search this blog. Just like it is just too hard to actually find real arguments to support his claims because all he has are the same lame tropes that have been repeated for years. Ones that he got from the silly websites he frequents (probably starting with John Scudamore).

We should probably pity the poor little NWO troll because it is too difficult for him to think for himself... it is just too h...a...r....d. But no, it is just time to laugh at his repetitive nonsense stuck in his welded shut scull.

@Chris, I'm quite certain I and other readers can examine what Angell and Ioannidis have to say and form their own conclusions, without relying on the author of this blog to act as a perception intermediary. :)

In other words, it is as I suspected. You are afraid to see what I've written about John Ioannidis' work. No surprise there.

The other readers know how to search this blog for articles about their writings, and figure out that your conclusions are idiotic. So you are still just....

Other readers know how to use a perception intermediary rather than rely on their own judgment? I'm afraid you are correct there, in some cases. Fortunately, fewer and fewer cases these days, though. :)

@Chris,

Rats. You beat me to the punch on Nightingale.

She wrote her original "Notes on Nursing" advocating the right things (fresh air, clean sheets, light) without fully understanding why they were useful. But her resistance left when she looked at the evidence.

And if anyone should understand statistics, she should. She is not only the Mother of Modern Nursing, she is the Mother of Statistics.

Sorry, Panacea. :-)

I liked that her story parallels to often touted Semmelweis bit, but unlike him, she was persuaded by her statistics. And she used pie charts!

The troll does not understand how science change, and her story is so much better that the silly one he and every other anti-science troll used. Statistics is something that changes the course of scientific thought, not "mavericks bucking the system." Something he would learn if he read the two books I posted. But he chooses to stay willfully ignorant, and not realizing why we think he is a fool.

Two of the more notorious cases of known massive medical fraud occurred with the so-called "Swine Flu epidemics" of 1976 and 2009. The 1976 fraud was covered by 60 minutes in this video: https://www.youtube.com/watch?v=8elE7Ct1jWw

The 2009 Swine Flu fraud was covered by Sharryl Attkisson, then a CBS reporter. In the summer of 2009, the CDC quietly stopped Swine Flu cases in the US. Through FOIA requests, Attkisson discovered that, before the CDC had stopped counting cases, they had learned through actual test results that almost none of the cases they had counted as Swine Flu was, in fact, Swine Flu--or any kind of flu at all. http://www.cbsnews.com/news/swine-flu-cases-overestimated/

And what better way to cover up a lie than to tell a gigantic lie? Here, a 2009 WebMD article gives the CDC’s peculiar position: “Shockingly, 14 million to 34 million U.S. residents — the CDC’s best guess is 22 million — came down with H1N1 swine flu by Oct. 17 [2009]." http://www.webmd.com/cold-and-flu/news/20091112/over-22-million-in-us-h…

Just another example of why no information emanating from the CDC can be trusted.

Sharyl Attkisson? Hahahaha. Sorry. I couldn't help but laugh. She's long been antivaccine, dating back at least ten years ago, when she was still a CBS reporter. (Indeed, based on some good reasons, I suspected her of feeding information to antivaxers about her reporting on the down low.) Search for her name here, and you'll see numerous examples documented over the last decade or so. The reason I laugh is to see you impugn the CDC as being unreliable when Attkisson's reporting on vaccines and health issues is the very definition of unreliable.

Yes...the 60 minutes story is equally hilarious. Do you have any evidence to refute Attkisson's findings--that before the CDC stopped counting Swine Flu cases in 2009, most of the actual tests results were negative?

I’m quite certain I and other readers can examine what Angell and Ioannidis have to say and form their own conclusions, without relying on the author of this blog to act as a perception intermediary.

Yes we have and twits like you love to abuse those articles revealing your ignorance about vaccine science even more.

Can NWO troll say "cherry picking"? And still to lazy to use the search box. Hilarious!

Cherry pick!
(Head em' up!)
Move goalposts!
(Move 'em on!)
More insults!
(Head em' up!)
Rawhide!
Cut 'em out
(Paste 'em in!)
Paste'em in
(Cut em' out!)
Cut 'em out
Paste 'em in,
Rawhide!
Keep trollin', trollin', trollin'
Though they're disaprovin'
Keep them comments trollin'',
Rawhide
Don't try to understand 'em
Just rope, laugh, and ignore 'em
Soon we'll be discussin' bright without 'em

NWO Reporter, are you just thread hopping to avoid the untenable positions you keep putting yourself in? Because I see a lot of unanswered questions, starting with that FOIA gaff of yours.

@NWO Reporter:

Sharyl Attkisson is also notorious for panicking about a stuck delete key on her laptop that she thought was a hack attack by the Obama administration:
http://www.vox.com/2014/10/31/7140247/the-right-is-convinced-obama-hack…
She's about as sharp as a billiard ball.

So, did you find the 60 minutes piece about the 1976 Swine Flu fraud as hilarious as Orac did?

Did you come up with any evidence to refute Attkisson’s findings that, before the CDC stopped counting Swine Flu cases in 2009, most of the actual tests results were negative? Or is that evidence still MIA, buried under the usual mountain of ad hominem?

@ Chris,

I like using the story of Semmelweiss, Nightingale, and germ theory to illustrate the importance of infection control with my students. It's a compelling story, and it brings home the whys very clearly to them.

Do you also discuss with your students that 80,000 people die every year from infections acquired in hospitals--today, in the modern days of medicine?

NWO Reporter,

I’m quite certain I and other readers can examine what Angell and Ioannidis have to say and form their own conclusions, without relying on the author of this blog to act as a perception intermediary

What is your evidence that we rely only on a perception intermediary to get acquainted with the scientific literature?

Alain

Did you come up with any evidence to refute Attkisson’s findings...?

Yep.They are Attkisson's findings. That's good enough for me.

Your logical fallacy is: ad hominem. "A logical fallacy is a flaw in reasoning. Logical fallacies are like tricks or illusions of thought, and they're often very sneakily used by politicians and the media to fool people." https://yourlogicalfallacyis.com/ad-hominem

NRO Reporter: could you please inform us of (1) the number of people who die every year due to infections that are not acquired in hospitals compared to the number who die every year due to infections that are acquired in hospitals, and (2) whether or not any sentient being should be surprised that people are more to be acquire infections if they are surrounded by sick people? Thanks.

Don't demand that others do your research and make your arguments for you. Maybe hospitals don't have proper isolation and sterilization protocols. Maybe they have them, but don't follow them. It sounds like you are trying to suggest that 80k+ deaths every year are inevitable from infections acquired in hospitals. If so, make a case for it if you like.

@ NWO Troll

Yes, I discuss the risks of death and disability from infection with my students.

I do it in professional, clinical manner, with the goal of teaching them how to prevent as well as administer treatments to care for infections.

Now buzz off troll. The adults in the room are talking.

Yep.They are Attkisson’s findings. That’s good enough for me.

Someone has prior form of making crap up and stove-piping other people's scammy fabrications, they're going to keep making crap up. After a certain point, it is not cost-effective to provide that person's latest fabulations with a detailed rebuttal.

@NWO Reporter
Did you ever check what was Marcia Angell's position on vaccines ?

I have a theory about why ppl get into woo.

A few yrs ago I had frozen shoulders and the pain was unbelievable. I couldn't lift my arms, couldn't walk my dogs or put my clothes on w/o help. My ortho doc gave me shots and I went to PT but nothing worked.

He finally booked me to have manipulation under anesthesia to break up the capsules. A week before that procedure I went to a hypnotist to help me sleep better since the pain was keeping me up and sleep meds make me a little crazy. Before he started he asked if there was anything else I wanted to address and I said, kind of flippantly, "yeah, if you can cure my frozen shoulders that would be great."

When I came out of my little trance state my shoulders were pain free. I could raise my arms, swing them side to side--hallelujah! I still had weakness but no pain. I cancelled the MUA and yrs later I am still fine.

Now, my theory is that the problem was probably psychological. I can't say why it might have happened at that particular time, but I don't think it was a physical (as in organic or traumatic) problem.

I have since come across some ppl in my family who have had conversion disorder (one diagnosed and one with me guessing). One of my nieces is literally wheelchair bound and has nothing "wrong" with her. She went from healthy to having the symptoms of cerebral palsy over several months. An aunt when she was younger had a limp and what they called a "dead arm" back in the 50s. Doctors found zero wrong with her. Then she had a born again experience and was "healed."

So...my theory is that quackery "works" in psychological disorders being cured by psychological means, even if the reasoning brain has no idea this is happening. Can acupuncture cure cancer? No. But can it help someone quit smoking or with tension headaches? Sure if the emotional brain believes that it's real and doing some amazing mojo to it. and the headaches are not from tumors or whatever.

Does this make sense?

"Disruptive" functional medicine at the Cleveland Clinic: Disrupting medicine by mixing quackery with it

oracknows — Wed, 01 Mar 2017 02:00:14 +0000

"Disruptive" functional medicine at the Cleveland Clinic: Disrupting medicine by mixing quackery with it

That the Cleveland Clinic has become one of the leading institutions, if not the leading institution, in embracing quackademic medicine is now indisputable. Indeed, 2017 greeted me with a reminder of just how low the Clinic has gone when the director of its Wellness Institute published a blatantly antivaccine article for a local publication, which led to a firestorm of publicity in the medical blogosphere, social media, and conventional media to the point where the Cleveland Clinic's CEO Dr. Toby Cosgrove had to respond. Dr. Cosgrove was—shall we say?—not particularly convincing. Indeed, even as he voiced support for vaccines (good), he was clearly in denial that all the pseudoscience and quackery that the Cleveland Clinic has embraced under his leadership facilitated antivaccine views because so much of it included practitioners and belief systems that tend to be antivaccine. As I like to point out in response every time Cosgrove's becomes all righteously indignant about the criticism the Cleveland Clinic receives for its embrace of pseudoscience and his being shocked—shocked!—that there are antivaccine beliefs in a physician in a leadership position in his Wellness Institute, he hired Dr. Mark Hyman to set up a "functional medicine" (FM) clinic at the the Clinic, the same Dr. Hyman who co-authored with ~~vaccine safety activist~~ antivaccine activist Robert F. Kennedy, Jr. an antivaccine propaganda book, Thimerosal: Let the Science Speak: Mercury Toxicity in Vaccines and the Political, Regulatory, and Media Failures That Continue to Threaten Public Health, a book full of antivaccine fear mongering of the mercury militia variety. I also note every time Dr. Cosgrove gets his knickers in a bunch over this that Hyman and Kennedy published that book the very same year that Cosgrove hired Hyman. Not only that, but RFK Jr. and Hyman appeared on The Dr. Oz Show to promote the book a mere week and a half before the Cleveland Clinic announced Hyman's hiring.

So it was with some interest that I came across an article praising the Cleveland Clinic's embrace of pseudoscience as "disruptive innovation." Yes, it was co-authored by an old "friend" of the blog, Glenn Sabin. We've met Sabin multiple times before, most recently earlier this year when I became aware of a book he published about integrative medicine's latest rebranding of itself. Years before that, he had bragged that integrative medicine is brand, not a specialty, and this was one of the few areas where I actually agreed with Sabin, just not in the way that he meant it. For instance, he liked how "complementary and alternative medicine" (CAM) had been "rebranded as "integrative medicine." He also thinks integrative medicine is a good thing, whereas I view it—and quite rightfully so, I might add—as "integrating" quackery with real medicine, at least where integrative medicine doesn't rebrand science-based health interventions like diet and exercise as somehow being "alternative" or "integrative." So enamored of integrative medicine is Sabin that he also recently wrote a short book on what he considers to be the 125 most important milestones along the path to the acceptance of "integrative medicine," or, as I refer to them, milestones on the way to normalizing quackery.

In their article, Disruptive Functional Medicine Innovation Drives Value-based Future at Cleveland Clinic, Walsh and Sabin start out quoting Clayton Christensen:

The instinct of every leader is to frame disruption as a threat—even if it constitutes an extraordinary opportunity for growth by reaching more people more affordably. If today’s hospitals set up focused-hospitals to disrupt themselves…the evolution can be profitable rather than painful.

So right from the beginning, you see that they view integrative medicine and FM at the Cleveland Clinic as "disruption" in the service of "innovation":

Christensen, one of the nation’s leading authorities on disruptive innovation in business, wrote those words at a time after the early forces of healthcare disruption had started coalescing, around 2000.

He would not have recognized them at that time because they were not dependent upon the technological advances he often cites as the basis for successful disruption. Rather they were, and remain, disruptive in how patients can be most beneficially treated. This evolution has often been painful, and it may yet produce profit, if, as we will see, that disruption establishes value based on quality outcomes, reduced costs and patient satisfaction. The Triple Aim by any name.

Those early disruptive forces in care first stirred in the U.S. in the 1980’s, initially in the form of formal recognition of complementary and alternative medicine (CAM) modalities by the U.S. healthcare system. The subsequent growth of clinical businesses and their patient populations (to shocking levels by 1991²) was completely driven by patient preferences and out-of-pocket spending that was not reimbursable.

There are two interesting, perhaps unintentional, admissions in just this brief passage. First, a whole lot of "integrative medicine" is not reimbursable by insurance companies because they don't cover it. Why don't they cover it? The reason is simple: It's not science- and evidence-based. Once you get away from the interventions that integrative medicine has rebranded, such as diet, exercise, lifestyle, and a handful of others, such as a very few herbal medicines, you're left with acupuncture, reiki, homeopathy (and, yes, homeopathy is still used because naturopathy is popular in integrative medicine, and you can't have naturopathy without homeopathy), reflexology, chiropractic, and a large number of other pseudoscientific modalities. That's what's being integrated into medicine.

The second admission is that this integration has been driven by patient preferences. Now, I don't agree that it's been "completely" driven by patient preferences. There are plenty of physicians who have, for whatever reason, fallen into pseudoscience and offer these services to patients. Sure, many of them are responding to what they see as a marketing opportunity, but there are a lot of docs who have gone into "integrative medicine" because they've become true believers as well. Be that as it may, the National Center for Complementary and Integrative Health (NCCIH) doesn't exist because scientists and physicians clamored for it. The NCCIH exists because a woo-friendly politician aligned with quacks who sold laetrile and other nonsense foisted it on the NIH. Similarly it wasn't physicians who clamored for these programs Walsh and Sabin describe:

In the establishment of many Centers of Integrative Medicine at U.S. medical schools, growing from eight at its 1999 inception to more than 70 today, and leading to the formation of The Academic Consortium for Integrative Medicine & Health, ACIMH.

The growth of integrative health and medicine in the U.S. Military Health System and especially the VA that began in the wake of the wars in the Middle East, that now influences the approaches to care and healing in these and other major institutions.

The investment in integrative medicine and health units at academic and non-academic regional and national hospital systems such as Mayo, Allina, Medstar, Sutter Health, Meridian Health and Beaumont Health (many, including the VA, are now members of ACIMH).

Yes, over the years I've discussed these developments, such as the infiltration of quackery into medical school education and academic medical centers and the VA, as well as the proliferation integrative medicine centers like the Cleveland Clinic's Wellness Institute:

If there is a model of disruptive innovation in healthcare that Christensen might recognize today it is probably located at the Cleveland Clinic, where its Center for Functional Medicine (CC-CFM) is as close to a ‘focused-hospital’ bent on deliberate self-disruption as we are likely to find.

Established in 2014 after CEO Delos (Toby) Cosgrove, MD and Mark Hyman, MD, current chairman of the Institute for Functional Medicine, agreed to bring to the Cleveland Clinic functional approaches to identifying root causes of illness and to treating conditions in collaborative fashion.

Behind this decision was the intention to create a sustainable business model based on value that would scale in such a way as to establish new relationships with insurers and make the functional approach a norm in healthcare.

In presentations at the Personalized Lifestyle Medicine Institute (PLMI) conference “Harnessing the Genomic Revolution: Breakthroughs in Personalized Precision Health Care” in October of 2016, Dr. Hyman, now Director of CC-CFM, and Patrick Hanaway, MD, its Medical Director, described the careful, intentional efforts being made to establish this business model grounded in the precepts of the Triple Aim: reduced costs, better outcomes and greater patient satisfaction.

Let's step back and remember what FM really is. Basically, FM represents itself at getting at the "root cause" of illness and attacking it directly. In reality, FM is more like "making it up as you go along" the same way that so many other alternative medicine practitioners do. Basically, FM involves the worst of both worlds, alternative medicine and conventional medicine. Like the worst aspects of conventional medicine, FM involves massive overtesting, with FM doctors sometimes testing dozens or scores of lab values. They claim they know what these values mean and how to treat them based on evidence, but seldom do. So, like alternative medicine practitioners, they make it up as they go along. Of course, when you test so many different lab values, inevitably by random chance alone one or more of them will be abnormal, because normal lab values are usually set so that their ranges encompass 95% of normal people. So you get things like hormone panels, thyroid panels, metabolic panels, micronutrient testing, and many, many more. You get bogus tests like provoked urine heavy metal testing, in which a patient is given a dose of a chelating agent and then a urine test for heavy metals is carried out. Inevitably the values are high, and FM docs use them to justify chelation therapy.

Now look at what they're doing at the Functional Medicine Center:

Dr. Hanaway’s presentation described the programs and clinical systems, analytical tools, team-building and research programs being put in place to create this paradigm of value. These include:

Conducting a select group of small RCTs.

Working with the Institute for Functional Medicine to standardize clinical protocols.

Collecting and integrating quality, outcome and cost data (often for the first time ever).

Collecting patient case studies that illustrate the patient experience.

[Note: Dr. Hanaway’s full presentation (40 min.) is available here on the PLMI web site (requires free registration). Click on the “Day 2” tab.]
In reviewing these efforts in some detail, Hanaway noted, “We’re in a learning process of ‘How do we put these tools together?’ We look at quality, we look at cost, and work toward value.”

Let's see: Do a few small RCTs? That's a perfect recipe for either a bunch of negative results because the trials are underpowered or for spurious results. Collect case studies? That's the lowest form of clinical evidence, not even a case series! Then there's this:

Another measure, using the NIH’s PROMIS-10 tool to compare the results of “clinically significant improvement” from CC-CFM treatments to those of the Clinic’s family medicine unit (CC-FM) (already among the nation’s best for patient clinical improvement), demonstrates the following improvement scores:

CC-CFM: + 38.7%

CC-FM: + 27.4%

In part this nearly 40% difference reflects what Hanaway reports as the CC-CFM’s success in encouraging patients to actively embrace activities that support their health (through ‘patient activation measures’). Indicative of this were results from comparisons of patients being treated for fatigue, mood, and autoimmune conditions.

And here's where the rebranding comes in. Remember, the Center for Functional Medicine claims that its greater success is due to its ability to get patients to "embrace activities that support their health." Whenever I discuss FM, I'm forced to conceded that there is a grain of good there. There are some things that FM gets right. The problem is that these things tend to be no different than the sorts of things every good primary care doctor should be getting right anyway, such as emphasizing healthy lifestyles, good nutrition, enough exercise, adequate sleep, cessation of habits known to be deleterious to health (e.g., smoking). How do they do it? One advantage FM doctors have over primary care doctors practicing science-based medicine (SBM) is that, because insurance often won’t cover much of what they offer, FM doctors tend to spend more time with patients, which is something that primary care doctors have a harder time doing these days. They emphasize prevention, which is a good thing but again something that good primary care doctors do anyway. Unfortunately, the FM version of “prevention” isn’t always in line with the SBM version of prevention. Where FM doctors go so very wrong is in what Grant Ritchey described as a major unstated premise. That premise is that FM really does address the root causes of disease better than conventional medicine. FM also encompasses a lot of quackery, such as acupuncture, chiropractic adjustments, and especially “detoxification” programs. It’s little wonder that many naturopaths are very enthusiastic about FM.

So here's the problem. Whatever benefit there is from FM almost certainly derives from the things that primary care physicians do right, such as getting patients to improve their diet and exercise more, which FM docs could well be more successful at because they can spend more time with each patient. There's nothing magical about that. Also notice how the RCTs that are being done are not testing individual FM interventions, but rather the whole package. If the improvements seen are driven primarily by lifestyle interventions, they'll never know that the overtesting and the woo that FM slathers over the few good things it does had nothing to do with the patient improvements reported. Maybe that's the point. After all, the main purpose of the "research" Hyman is doing at the Center for Functional Medicine seems to be to show that FM saves money, in order to persuade insurance companies to reimburse for FM services.

Same as it ever was. The only "disruption" going on at the Cleveland Clinic involves finding a way to extract more cash out of offering pseudoscientific medicine in the form of "functional" medicine, traditional Chinese medicine, and all manner of quackery.

oracknows Tue, 02/28/2017 - 21:00

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After all is said and done, I still don't really know just what functional medicine is despite having read today's article (and even attending a lecture about it presented by a "doctor" of chiropractic). I'd very much appreciate it if someone can come up with a concise and informative definition that even a layman can understand.

Great article… Operation Backbone has been a disruptive mechanism in active duty,military and VA in a positive way…. The issue is not so much the disruptive nature in a positive way… It's the leadership at the CEO and CFO level, that doesn't understand what a mechanism can do in a positive way if it seems At First to go against the grain… It's the leadership that becomes Buried in paperwork bureaucracy… Not even so much the bottom line… But stepping outside the office and seeing the actual flow… That's what vision does - not the status quo. No excuses… There are tremendous success out there however red tape is not an alternative to constantly challenging the status quo, or the flow and nature of a disruptive new mechanism that can alter the path for so many people now and in the future

Ah, the old Galileo Gambit: People who disagree with us really are just trying to protect the status quo for some nefarious reason.

Functional medicine = Functional entertainment

I so thoroughly detest the abuse of those words "disrupt" and "innovation." They do not mean what their chirpy promoters think they mean.

"Oh boy!, let's go _break something!_" "And let's _make new_ regardless of whether new is better or worse, or even if 'new' is old, _and_ worse, as in homeopathy." The first sounds like Steve Bannon ideology, and the second sounds like planned obsolescence, and now it also sounds like quack-o-rama. Bleh.

What I'd really like to see some day: a line of peaceful protesters making their way through the Board meeting of one of these institutions that touts "disruption" and "innovation," chanting "Dis-RUPT! Dis-RUPT!" loudly enough to do just that for, oh, five or ten minutes, and then they all leave, having made the point.

Speaking of disruptive innovations in quackery, here's a prediction: e-Iridology. The computer takes a photo of your iris and spits out a diagnosis. There will also be an app that enables using your i-Thing to do it as a form of "selfie," and send in the photo for a "diagnosis" any time you like (only $49.99, act now!).

It will seem "sciency" because it comes with an app and a robot, and as we all know, anything with an app and a robot is super-duper cool. Someone will make a lot of money on this and patients will die from false negatives for dangerous diseases. FDA might shut it down in 2022 or so, depending on election outcomes in 2020. Hurry! hurry! hurry!

You want to know the crazy thing, Mr./Ms. Squirrel? If I marketed a b.s. auto-diagnostic I could make a fortune - my financial troubles would be over forever. Or be a professional science denier. Or a professional RW troll.

So many times have I refused to participate in lucrative swindles, and my reward is poverty. At least the old lady next door whose walkway I shovel for free thinks I will be rewarded by Jesus. Sometimes I wish I could make myself believe this. But good deeds aren't if you do it in anticipation of reward.

Those that readily accuse RI commenters of being 'shills' are not simply wrong - they have things exactly backwards. Very, very bad taste. It is principled advocates of reason who willingly accept financial loss to defend what is right.

Walk in peace, scientific skeptics, and always remember that the principle of charity can go too far. You are morally superior to Kennedy, Gordon, Wakefield, and that entire cast of venal clowns. You don't have to be self-righteous or a 'dick' to have pride in yourself.

"After all is said and done, I still don’t really know just what functional medicine is despite having read today’s article (and even attending a lecture about it presented by a “doctor” of chiropractic). I’d very much appreciate it if someone can come up with a concise and informative definition that even a layman can understand."

Functional medicine: a system which functions to provide a beneficial outcome for farsighted practitioners.

I so thoroughly detest the abuse of those words “disrupt” and “innovation.” They do not mean what their chirpy promoters think they mean.

The game here, as when these words are similarly abused in technophilic and Silicon Valley contexts, is buzzword bingo. Certain people have gotten used to allegedly novel schemes being marketed in just this way. Why should medicine be different? "Disruption" is made to sound exciting. Never mind that it tends to be "interesting" in the Chinese curse sense of the word.

And as in Silicon Valley, a handful of people who have the luck to be in the right place at the right time make out like bandits.

The main difference between disruption in medicine and disruption in the tech business is that occasionally the latter ends up helping the consumer directly. Several iDevices have served as examples over the years. When this kind of disruption helps a patient, it is invariably a combination of luck and the placebo effect.

“Oh boy!, let’s go _break something!_”

"Let's go get sushi and not pay."

What I’d really like to see some day: a line of peaceful protesters making their way through the Board meeting of one of these institutions that touts “disruption” and “innovation,” chanting “Dis-RUPT! Dis-RUPT!” loudly enough to do just that for, oh, five or ten minutes, and then they all leave, having made the point.

There's a Been Down So Long reference to be had here, too, but the word on the street is that there's a bunch of mass storage to be had in the campus library's electronic recycling, which has been vitally important to me lately.

No need to worry about the chemical medicine paradigm. It will continue to thrive and be hailed by unquestioning believers, even as our population steadily becomes even more unhealthy than it is already, while spending more than ever.

Trauma care is great in the US, but there's a relatively small market for it. The real money is in the creation and perpetuation of chronic disease, because there's a constant supply of symptoms to mask and tests to perform.

Even when it's performing at its optimum, the modern medical system is the third leading cause of death in the US--as researchers from Johns Hopkins pointed out in studies from 2000 and 2016. See http://www.drug-education.info/documents/iatrogenic.pdf; and Makary Martin A, Daniel Michael. Medical error—the third leading cause of death in the US BMJ 2016; 353 :i2139.

So-called "integrative medicine" is just responding to a demand that was inevitable. Sure, there have always been opportunistic "quacks," but they'll never rise to the level of the official quacks running a system that kills, conservatively, over 250,000 people every year.

Lol. If only the problem were isolated to a single source, it could be pretty easily resolved. :D

But 'disruptive' sounds so, so... rebellious and paradigm shifting!

Let's f@ck up the establishment and usher in a new era ...
or something.

NWO; yes medical error does either directly or indirectly cause the deaths of a number of people per year (I believe the 250,000 number is has been strongly reputed). However, how many people every year die from using FM, ND, HM, wheatgrass, etc, etc. Ask the young model how well having a chiro twist you neck works: oh sorry you can't she's dead.

Real modern medicine works and I am proof. In the last 3 years my prostate cancer is cured or in total remission and I survived a heart attack in which I had less than a 7% survival chance. I've had even better news on the heart attack: my ejection rate during the attack was below 35% and as of December my ejection rate in now over 60% (55% being average) which suggests little to no heart muscle damage.

NWO...wow.

First off the number if deaths CAUSED by medicine is a flat out lie. Someone who is diagnosed as terminal is not killed by science. Second, live expectancy is longer now than pre science based medicine, suggesting that we are healthier. Death is pretty unhealthy. Third, new diseases and disorders are found as we discover them, primarily because we now know what we are looking for in research. It is foolish to talk as if society was better off in the 1890s.

Well, Dr. Starfield's study identified 106,000 deaths per year caused by properly prescribed and administered, FDA approved drugs. So that would be the most direct "cause" by medicine--along with 12,000 deaths per year from unnecessary surgery.

In other paradigm-shifting news...

It seems that woo-meister extraordinaire, Gary Null, may be soon dismissed by his long time land-based (free) airtime provider, WBAI. He lost one day a week months ago and ranted that he may lose even more. They allowed him time to run a promo for his 'health retreats' that will benefit the station as well as himself. Long story about retreats available upon request.

Although he maintains that he has other outlets broadcasting his dreck, ( unnamed ), an internet locus and woo by phone, I believe that he gets the most money via the radio station because of his longtime association with it and the fact that it reaches NYC money. Who else can afford powdered, dried vegetables at high prices?

NWO Reporter:

Trauma care is "great", because it is based on the results of scientific research. Chronic care is terrible because it's based on the results of scientific research.

How does that work?

Denice @ 17:

You have made my day.

@ TBruce:

I always wonder how they manage to separate the two types of care.
Aren't education, research and training in medicine beyond such artificial and unrealistic distinctions?

It's hilarious to hear them harp upon this tune.

"No need to worry about the chemical medicine paradigm." Oh good. That means the chemical constituents of plants will continue to show activities, long after extracts of the plants themselves fail to live up to their purported use in folk-medicine, or the hyperbolics of marketers.

Chemgeek you ass-ume so much.

Most prostate cancer is genetic, dairy products have nothing to do with it. Let me think; the last time I had a glass of milk is around ten years ago. I did more than a google u research on the subject.

The reason I am in the 7% has to do with where I work (medical facility) and the care I received from here to the treatment hospital. I also lucked out I had the best cardiologist in the area treat me.

@ TBruce:

I know that he has been dismissed and recalled previously BUT we can hope. If he only gets one day a week, it might really eat into his profit margin.

Oh, and we have to stop meeting like this, Bruce.

There are hormones in Dairy products and the Chinese have very low rates.

Did you have any specific career paths in mind for your new job search, Fucklesworth?

From American Cancer Society:

Men who eat a lot of red meat or high-fat dairy products appear to have a slightly higher chance of getting prostate cancer. These men also tend to eat fewer fruits and vegetables. Doctors aren’t sure which of these factors is responsible for raising the risk.

Some studies have suggested that men who consume a lot of calcium (through food or supplements) may have a higher risk of developing prostate cancer. Dairy foods (which are often high in calcium) might also increase risk. But most studies have not found such a link with the levels of calcium found in the average diet, and it’s important to note that calcium is known to have other important health benefits.

Research shows that there may a slight increase in prostate cancer risks from dairy and red meats but whether it is a causation or a correlation is unclear.

NWO Reporter

Well, Dr. Starfield’s study identified 106,000 deaths per year caused by properly prescribed and administered, FDA approved drugs.

The real follow up question would be, how many are saved each year with the same drugs. Anticoagulants are one of the more dangerous prescription drugs by number of side effects and are often used as examples when talking about drug-related deaths. Except demonstrably they keep high risk patients alive longer than comparable patients without the drug. Chemotherapy also has nasty side effects, and sadly, many cancer patients undergoing chemo die. Now is this due to the drug, or the cancer? (you can argue for or against on individual cases, but again, statistically, patients on chemo survive much longer than comparable patients without).

There's also this:
https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6137a6.htm

Two main points to take away from this link is a) the average age of those patients dying from medical complications. And b) the overall decline in the rate - obviously the evil nefarious international disease-mongering conspirators are constantly getting better at keeping people alive. How utterly wicked of them.

Regarding Dr Starfield's article (JAMA 2000 v284(4):483): Among the caveats noted by her in the article, the first is "most of the data are derived from studies in hospitalized patients" - remember that these patients were hospitalized for a reason. These are not deaths occurring in otherwise healthy patients looking for some dietary counseling during their annual well-care checkup. It is not possible to assess how many of these patients would have died regardless of treatment chosen.

A "caveat"? Seems more like a limitation. Most patients who die from unnecessary surgery, medication errors and other errors in hospitals, and hospital-acquired infections, would likely die in a hospital, but by no means all. And considering that many people outside of hospitals are also imbibing properly prescribed and administered, FDA approved drugs, the total deaths from them each year are likely much higher than the 106,000 that occur just in hospitals.

My limited experience with things like biopsy confirmed metastatic cancer is that conventional medicine flies blind with too few markers and panels to see the bullet coming, and fails frequently for this reason.

And then mainstream medicine fails to treat specifically enough with targeted, targetable mild materials (meds) for this reason , too. What I've seen with other patients' regular bloodwork makes me shudder. No wonder at all why so many crash and burn.

My limited experience with CAM/integrative medicine/FM is that morbid inflammatory processes can be attacked sooner, more thoroughly, more successfully, with less risky ammo than in regular clinical medicine.

That headline "Disruptive Functional Medicine Innovation Drives Value-based Future at Cleveland Clinic" really makes me think of the Weird Al song "Mission Statement", which is to say it's filled with meaningless buzzwords.

prn @28: If conventional medicine doesn't have enough markers and panels how would you suggest that we go about creating more? And what do you want the markers to be used for? Prognosis estimation, treatment planning, something else?
(I'm assuming that you're talking about biomarkers, please correct me if you mean something else.)

Some studies have suggested that men who consume a lot of calcium (through food or supplements) may have a higher risk of developing prostate cancer.

OMG. I wouldn't think that the ACS would set-up a strawman.

Low.

Huggins first demonstrated the androgenic dependence of prostate cancer as a potential cause, as well as a point of intervention and therapy, ultimately leading to a Nobel prize in 1966 [1,2].

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3134227/

It's hormones stupid.

Mr. Jost has not commented here since 2012. Travis Schwochert from Endeavor, Wisconsin, how is that job hunt going? Sorry, you can't blame us for your bad behavior. You should have thought about that before posting so much vile on the Internet.

A medium that never forgets.

Good bye, Travis Schwochert from Endeavor, Wisconsin.

I learned early on that the Internet does not forget, therefore I have always been careful about my behavior. Which was helped by having a very very common name. Still, I knew better than to post obscene photos, obscenities and meltdowns online.

Perhaps you should apply for Supplemental Security Income (aka disability payments) because your troll history is interfering with your job search.

Here is a quote from the cop when he was arresting some goons across the street for stealing barbecue supplies from a neighbor when they cried "But there are kids in the house!" (who they were ignoring)....

"You should have thought about that before you decided to steal."

Those goons provided a great deal of entertainment in our neighborhood. Instead of taping a piece of cloth over the window to block the street light, the idiot would go out and throw rocks at it to knock it out (stopped when we stood at the top of our steps to watch him). Then they had loud parties, but would not answer the door when when hubby pounded on their door with a rubber mallet. And it was fun standing next to my garage staring at this old guy as he honked his car horn that he summoned a female resident... he kept waving me away while I was standing on my own property! Cop cars made it a habit to park on our street during their breaks to watch that place.

It was so lovely when the guy who owned the rental next door begged their landlord to sell it to him. The landlord did... and before they moved out the idiots literally trashed the place. The building was expensively rebuilt, and nice folks moved in. Then the neighborhood became lovely and quiet.

Travis, we are waiting for you to shut up and leave. You are a stench on society. Don't expect us to help you find a job, you need to own up to your idiocy.

One big idiocy is that pharmaceutical companies get big bucks from preventing diseases... when in reality they make more by treating them:
a href="http://pediatrics.aappublications.org/content/early/2014/02/25/peds.201…">Economic Evaluation of the Routine Childhood Immunization Program in the United States, 2009

Also, for the record: I am a former aerospace engineer who just happens to be the mother of a young man with autism who has had a trip by ambulance because of a "grand mal" seizure from a now vaccine preventable disease.

I am not worthless because I fight for my kid. My kid is not worthless because he has potential. Mr. Schwochert, you need to reassess your priorities as you search for a job. Learn how to live with others who are different.

What "now vaccine preventable disease" are you alleging caused your child to have a seizure? I was browsing through the causes of non-epileptic seizures...I didn't see any "vaccine preventable" diseases on there--and that's in the Merck manual, where I assume they'd be anxious to mention such a cause. Just curious.

Disruption is so yesteryear. All the cool kids are pivoting.

Speaking of pivoting, Travis J. Schwochert, aka Fendlesworth, aka Fucklesworth, spin on this

And speaking of cool, man, that guy's got it made! If you do a Google search and misspell his name, Google suggests the correct spelling. How many of us can claim that kind of fame?!.

Heheh. Well, as you can see, the latest Fendlesock is gone. Sorry. I was up late multiple nights this week and fell asleep in front of the TV. So he had a few hours to play without my intervention. Such is life...

NWO @34: Are you familiar with the concept of a febrile seizure, the kind caused by high fevers, most often seen in children? Those can be caused by any number of pathogens that induce a high fever, some of which are vaccine-preventable and some are not.

HiB meningitis can also cause seizures, and thanks to the HiB vaccine, is now very rare.

JustaTech@30:
If conventional medicine doesn’t have enough markers and panels how would you suggest that we go about creating more? And what do you want the markers to be used for? Prognosis estimation, treatment planning, something else?

JT, conventional medicine simply doesn't use enough of what panels and markers that it's already got. There are several problems. Clinical medicine is so used to shortcuts and assumptions for the broad field, that doctors seem unfamiliar with a lot of useful literature and extended analyses in detail in any specific area. With the extra lab data, a lot of minor problems that can unravel you are easier to spot, delineate and/or adjust.

The extra markers improve monitoring and detection. problem detail, prognosis estimation and alteration, treatment planning and targeting - as much of the whole enchilada as one can research.

Of course I'll hear "cost", "overdiagnosis", "polypharmacy", "futility", "iatrogenic risks", (assuumed) "net benefit" (of assumed tretments) etc. These objections more reflect the problems of the current conventional medical models than (alternate medical) reality to me.

Also I'm finding that some panels are already run. Even if I didn't initially ask for them, some are recoverable after the initial results are in, or that they were running them anyway.

if ONLY the problem was limited to the Cleveland Clinic.

If only...https://www.statnews.com/2017/03/07/alternative-medicine-hospitals-prom…

Deep Throat advice is more relevant than ever; "Follow the money!"

SMH!

There are pros and cons of every issue, and there are always are some that twist things around as a money making scheme. As an RN working with the geriatric population, I wish we could all come together and find a happy medium. My patients are prescribed beneficial medicine, but are receiving little to no education on their nutrition and exercises plans. I feel like a better plan for all of us would be to go back to the basics of nutrition, exercise, sleep, stress relief, and hydration. And then on top of that, we could educate the children and families of these patients to help further the prevention of diseases. I believe functional medicine's core is getting back to these basic underlying issues, and although it might not be as scientific or glamorous, I feel that these are the basic components that the general population need help with to increase their quality of life.

Homeopathy for breast cancer surgery? Isn't it bad enough that the patient has cancer and needs a mastectomy?

oracknows — Fri, 17 Feb 2017 06:37:24 +0000

Homeopathy for breast cancer surgery? Isn't it bad enough that the patient has cancer and needs a mastectomy?

I like to refer to homeopathy as The One Quackery To Rule Them All, so much so that I almost always call it that within the first two paragraphs of any post I write about some tasty bit of homeopathy pseudoscience. It's also a wonderful tool for teaching critical thinking because it's easy to explain and people grasp intuitively why homeopathy is pseudoscience when it's explained properly to them. Basically, it's because of homeopathy's two laws. The first is the Law Similars, which states that, relieve a symptom, you must use something that causes the symptom. It's nonsense. There's no science behind a general rule like that. Then, there's the second law, the law of infinitesimals, which states that a remedy gets stronger with dilution. That's why homeopaths serially dilute their remedies—with intense shaking between each step of dilution (homeopaths claim that the shaking, or succussion, is absolutely essential)—to the point where it is unlikely that there is a single molecule of the remedy left. For instance, a 30C homeopathic remedy is a remedy that's been diluted 100-fold thirty times, which results in a total dilution of 10^-60. Given that Avogadro's number (the number of molecules in a mole of a chemical) is roughly 6 x 10²³, that means a 30C dilution is over 10³⁶ more than Avogadro's number. Most people think that homeopathy is nothing more than herbal medicine and have a hard time believing it when I tell them what homeopathy really is.

All of this why skeptics frequently say that homeopathy is water, using that observation as the basis for jokes. Now, it's true that some "weaker" (i.e., less dilute) homeopathic remedies haven't been diluted enough times to dilute the original remedy to nothing (i.e., there's still something left), but most homeopathic remedies are, in fact, water or ethanol or whatever homeopaths used to dilute the remedy, usually pressed into sugar pills. A purer placebo, it is hard to imagine.

That's why it never ceases to amaze me when actual surgeons—even worse, breast cancer surgeons, my peeps!—forget everything they were taught in undergraduate and medical school about chemistry and physics and think that it's worthwhile to test a homeopathic remedy in a randomized clinical trial for breast surgery. After all, in such a trial, no matter what you choose as the placebo control, you're testing placebo versus placebo. In this case, it's surgeons in Italy, along with what appear to be basic scientists, testing the effect of a homeopathic remedy on healing in breast surgery. The remedy being tested is even more clearly water than even a 30C remedy. This time, the remedy being tested is Arnica montana, which is also known as wolf's bane, a flowering plant that is a member of the sunflower family. It's a common homeopathic remedy, and in this case it's really, really, really dilute:

A. montana 1000 K was in the form of drops in 30% hydro alcoholic solution, with sublingual absorption. The 1000 K dilution is a very high homeopathic dilution produced according to the French Pharmacopoeia, starting from a mother tincture (complete plant extract) which undergoes 1000 steps of successive dilution and shaking in a 30% water–alcohol solution. The mother tincture of the product used in this study contained a minimum content of 0.04% of sesquiterpenes (expressed as dihydrohelenanin tiglate). According to the Korsakovian dilution method, the same flask was used for the entire preparation: At each step, the flask was emptied of most of the liquid but not dried, and then immediately filled again with the solvent. Because the residual volume after emptying the flask certainly cannot be >10% of the total used in each dilution, the 1000th K dilution is sufficiently high that it certainly does not contain toxic amounts of the plant. The placebo drops were identical in appearance to the active drops, but included only 30% hydro alcoholic solution without any homeopathic dilution. The studied homeopathic treatment and the placebo were manufactured and supplied in strictly identical packaging by Laboratoires Boiron S.r.l. (Segrate, Milan, Italy).

So what we're talking about is one thousand 100-fold serial dilutions, resulting in a final 10^-2000 dilution. This is madness, as it's estimated that there are only around 10⁸⁰ particles in the known universe. Seriously, all that is left there is 30% alcohol. So basically the study I'm examining is testing the effect of 30% alcohol on wound healing in breast surgery. You'll see what I mean. Here's the rationale:

Surgery is not free from significant complications, despite advancement in surgical techniques and in perioperative care. One of the major complications, particularly for breast and soft tissues surgery, is post-operative bleeding which represents a critical and, in some cases, lethal risk factor [1,2]. Moreover, post-operative bleeding after breast surgery causes a severe discomfort to the patient, entailing the need for surgical re-intervention and sometimes blood transfusions. Another frequent complication of breast surgery is seroma, which often requires numerous accesses for outpatient drainage, finally resulting in a delay of adjuvant therapy administration and a significant psychological burden [3].

All of which is true, but doesn't justify this:

The risk of blood loss or seroma could be limited by identifying and then correcting potential triggers, but although this topic has been extensively studied, both hemorrhage and seroma are still largely reported [4,5]. Homeopathy could provide remedies based on compounds with anti-hemorrhagic and anti-inflammatory properties, but their use in diluted homeopathic solutions has been poorly investigated [6-9]. Indeed, some homeopathic remedies have been already evaluated in various surgical settings, however showing controversial effects [10-17]. Arnica montana is a plant belonging to the Compositae family and it grows in East and Central Europe [18]. In particular, its anti-inflammatory action is linked to the lactone helenalin that seems to be involved in the inhibition of the pro-inflammatory transcription factor nuclear factor kappa B (NF-κβ) [19-27]. A. montana has been recently evaluated in several surgical settings such as esthetic and orthopedic surgeries, but currently, no single study is available in literature on the effects of this homeopathic remedy in breast cancer surgery. In the present study, a homeopathic preparation of A. montana 1000 Korsakovian dilution (1000 K) was administered preoperatively and postoperatively in a placebo-controlled, double-blind clinical trial to patients undergoing unilateral total mastectomy, with or without reconstruction, to evaluate any favorable or adverse effect on post-operative blood and seroma collection from surgical drains.

OK, let me back up and do a bit of explaining here. After a mastectomy, we generally place a drain under the skin flap in order to collect the drainage, which starts out bloody but clears up until it's serum, usually pink with a little bit of blood mixed in. When the drainage decreases to below a certain volume per day, the drains are removed. Patients don't like drains because they're inconvenient, messy, and can clog, but without drains, it's almost inevitable that there will accumulate something that's called a seroma, which is a collection of that serous fluid under the skin flap left after the mastectomy. Sometimes two drains are placed, usually when the patient has her axillary lymph nodes (the lymph nodes under the arm) removed, because the cut lymph vessels also leak lymph and can result in a seroma.

In this study, the investigators studied the effect of 1000K A. montana compared to placebo on the following endpoints:

Duration of drainage, which was calculated from day 1 to the day of drainage removal
Time to reach a collected volume below 10 ml
Self-evaluation of pain, measured by VAS after surgery
The average time of hospitalization after surgery, which was measured in days following surgery
The presence of bruising and hematomas or breast swelling, measured both in terms of presence versus absence and of description or size
The differences between the volume collected on day 1 and the volume collected in each of the following days
Possible adverse reactions to treatment.

The patients were randomized to one of two grsoups:

The patients, according to the randomization list, received sublingually a dose of five drops of A. montana 1000 K 3 times a day, or placebo with identical times of administration, from 1st day before the surgery until the 4th day after the surgery (in total 6 days).

The results were analyzed using three models:

Model 1: Includes the treatment;
Model 2: Includes the treatment and the volume collected on the day of the intervention;
Model 3: Includes the treatment, the volume collected on the day of surgery, and patient weight.

Overall, 53 women were enrolled and randomized (26 in the A. montana group and 27 in the placebo group). One defect in this paper is that it didn't show a proper CONSORT flow diagram, which is generally mandatory for any halfway decent clinical trial. Be that as it may, what did the investigators find?

Nothing that spectacular:

The per-protocol analysis revealed a lower mean volume of blood and serum collected in drainages with A. montana (−94.40 ml; 95% confidence interval [CI]: 22.48-211.28; P = 0.11). A regression model including treatment, volume collected in the drainage on the day of surgery, and patient weight showed a statistically significant difference in favor of A. montana (−106.28 ml; 95% CI: 9.45-203.11; P = 0.03). Volumes collected on the day of surgery and the following days were significantly lower with A. montana at days 2 (P = 0.033) and 3 (P = 0.0223). Secondary end points have not revealed significant differences.

The first thing to notice is that there really wasn't a lower mean volume in blood and serum collected in the patients treated with the homeopathic remedy. the p-value was only 0.11. Now, apparently the criterion used by these surgeons for removing the drains was 10 ml/24 hours, because that was the endpoint the investigators looked at. My criterion is a bit more liberal. Be that as it may, the results are not impressive. For instance, take a look at this graph, which shows the change in drainage after day 1:

Yes, there does appear to be a slightly higher amount of drainage in the placebo group. It doesn't matter though. When it comes to breast surgery, what matters is not so much how much drainage is collected through the drains, but how many days before the drains can be removed. That number is the same for the placebo and homepathic A. montana groups.

To drive home the point, look at this graph, which shows the time for each group to reach a <10 ml of drainage/24 hours:

Basically, there was no difference, as I would expect. Certainly there is no clinically significant difference. Even the authors seem to know that:

In this study, which to our knowledge is the first to test the effect of A. montana in breast cancer surgery, we have measured the efficacy of the homeopathic treatment versus placebo in reducing the post-operative bleeding and seroma production in patients subjected to total mastectomy. The difference in the volume of blood and serum collected by drainages between the group of women treated with A. montana and those treated with placebo was statistically significant in the PP dataset, but only in the model which included, in addition to the type of treatment, the volume collected on the day of surgery, and the weight of the patient. Thus, we determine that these two additional variables have a considerable effect on the efficacy of the treatment, and further studies are needed to investigate their specific contributions.

Um, no. Basically you had to keep trying different models until you found one that produced a (barely) statistically significant result. I do have to give the authors props for this unintentionally hilarious observation:

The main limitations of the study were the relatively small sample, the analysis of post-operative recovery, which was limited only to 5 days, and the use of a high Korsakovian dilution which could have negatively impacted on the statistical significance of our findings. Observational studies with different Korsakovian dilutions could be useful to highlight any significant effect of A. montana and further validate these findings.

No. They. Could. Not. Be.

And this statement sums up every homeopathy study ever:

The scientific community often claims that homeopathy effects are not supported by rigorous clinical trials. This study, although reporting statistical significance only for some specific data settings, suggests a reduction in post-operative blood loss and seroma production in a group of women who underwent breast cancer surgery and treated with A. montana 1000 K.

Seriously, this is about as negative a study as can be imagined, just like every other study of homeopathy that's anywhere near competently designed and carried out. That's because homeopathy is water, or, in this case, 30% ethanol in water. At the dosage given, it there's not even enough alcohol there to give you a little buzz. It's like taking a teaspoon of cough syrup, many of which also have alcohol in them.

Once more, here we have a pseudoscientific and unethical clinical trial that shows...nothing. That's appropriate, though, because homeopathy is basically nothing.

oracknows Fri, 02/17/2017 - 01:37

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cancer

Clinical trials