March 2nd, 2009 by Dr. Val Jones in Health Policy, Opinion, Quackery Exposed
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I’ve been blogging a lot recently about the problems caused by health policy makers who don’t appear to understand medicine or science. I’ve also been lamenting the relative lack of physician input at the highest level of health reform. But today I’d like to present a prime example of the perfect storm in health policy: when willfulness, ignorance, and magical thinking combine to push an agenda despite billions of tax payer research dollars proving the futility of such efforts.
In this video, Senator Tom Harkin describes the impetus behind the creation of the National Center for Complementary and Alternative Medicine (NCCAM). Harkin suggests that he single-handedly introduced legislation in 1992 that created the Office of Alternative Medicine at the National Institutes of Health (NIH). This office paved the way for an entire new branch of research at NIH devoted to exploring the potential validity of non-science based medical practices such as homeopathy, acupuncture, traditional Chinese medicine, energy healing, meditation and more. He introduced the legislation because a friend of his experienced a substantial health improvement after trying one of these non-science based therapies. Essentially, an entire branch of the NIH was founded on an anecdote.
What’s worse is that after a decade of careful analysis of these alternative therapies, science has shown that not a single one of them appears to be efficacious beyond placebo. One would think that Senator Harkin would be embarrassed by the colossal waste of tax payer resources spent on this pet project of his. But no, instead he chastises the scientists who did the research, saying that they had failed to do their job of “validating” the therapeutic modalities. Wow. I guess he was never interested in finding out the truth about what works and what doesn’t – because when objective analysis reveals that these modalities don’t work, then the science must be flawed.
Now don’t get me wrong – healthy eating, regular exercise, emotional and psychological support are critical factors in good healthcare, and I fully believe that America needs to become a “wellness culture” in order to prevent chronic diseases and improve quality of life. I also believe that Americans are often over-treated and over-medicated when lifestyle interventions might be their best treatment option. However, in encouraging behavior modifications, we don’t need to foist placebo therapies on them under the banner of science. The problem with “integrative medicine” is that it takes some good medical principles and infuses them with scientifically debunked and outdated systems of thought (debunked repeatedly by NCCAM, the very scientific body that Harkin hoped would validate them.)
What we really need to do is stop splitting the practice of medicine into “integrative” vs “non-integrative” and simply follow scientifically vetted best practices. Patients need a comprehensive approach to their health, a medical home with a good primary care physician coordinating their care, reliable health information to support their decision-making, a strategy to eat well and exercise regularly, and mental health services as needed.
Senator Harkins’ plan to continue flogging the alternative medicine “dead horse” is not helpful – it’s not good science, and it’s not a good way to spend our tax dollars. I can only hope that one of the positive effects of Comparative Clinical Effectiveness Research will be to put an end to the promotion of the ineffective therapies that Harkin fervently hoped would be validated. I also hope that the new Federal Coordinating Council will not support funding to pet projects that are founded upon anecdotes, pseudoscience, and wishful thinking. Now more than ever we need good science underpinning our healthcare spending, and we need informed scientists advising our government on priorities for America’s health.
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Addendum:
More outrage from the medical blogosphere over Harkin’s views:
1. Dr. David Gorski: Senator Tom Harkin: “Disappointed” that NCCAM hasn’t “validated” more CAM
2. Dr. Peter Lipson: Harkin’s War On Science
January 31st, 2009 by Dr. Val Jones in Expert Interviews, Opinion, Quackery Exposed
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David Kroll, Ph.D. and I share more than an appreciation for bibs and crab legs (pictured at left during our recent “academic” rendezvous) – we are pro-science bloggers who want to understand the evidence for (or against) health treatment options, both in the natural product world and beyond. At our recent meet up at The Palm we discussed homeopathy – a bizarre pseudoscientific approach to medicine often confused with herbalism. Homeopaths believe that “like cures like” (for example, since an onion causes your eyes to water and nose to run, then it’s a good cure for a cold) and that homeopathic remedies become more potent the more dilute they are. So if you want a really strong medicine, you need to mix it with so much water that not even a molecule of it is left in the treatment elixir. Of course, homeopathy may have a placebo effect among its believers – but there is no scientific mechanism whereby tinctures of water (with or without a molecule of onion or other choice ingredient like arsenic) can have an effect beyond placebo.
David graduated with his B.S. in toxicology from one of the most prestigious schools in the country, the Philadelphia College of Pharmacy and Science (PCP&S). In the early 1900s PCP&S graduates were critical players in combating snake oil hucksters and establishing chemical standards, safety, and efficacy guidelines for therapeutic agents. So it was with utter amazement that he received recent news that PCP&S was planning to award an Honorary Doctorate of Science to a major leader in homeopathy – on Founders’ Day, no less.
“Our founders would be rolling in their graves,” David told me. And he wrote a letter of complaint to the University president which you can read here. This is a choice excerpt:
Awarding Mr. Borneman an Honorary Doctor of Science is an affront to every scientist who has ever earned a degree from the University and, I would suspect, all current faculty members who are engaged in scientific investigation. Homeopathy is a fraudulent representation of pharmacy and the pharmaceutical sciences that continues to exist in the United States due solely to political, not scientific, reasons. Indeed, homeopathic remedies are defined as drugs in the Federal Food, Drug, and Cosmetic Act [21 U.S.C. 321] Section 201(g)(1) as a result of the 1938 actions of U.S. Senator Royal Copeland (D-NY), a noted homeopath of his time. But scientifically, homeopathic remedies are nothing more than highly-purified water misrepresented as medicine based upon an archaic practice that is diametrically opposed to all pharmacological principles.
Honoring people who actively promote pseudoscience is wrong in many ways as David points out. I would also add that doing so confuses the public. If academic institutions committed to scientific integrity lend their names to cranks, then it makes it more difficult for the average person to distinguish quackery from science. I have the utmost sympathy for the patients out there who are trying to figure out fact from fiction in medicine. That is why I have a “trusted sources” tab on my blog – please click on them for guidance regarding health information you can trust.
As for PCP&S, if they value their academic principles (as no doubt many within the organization do) the president should rescind his offer to honor Mr. Borneman’s “entrepreneurial spirit” on founder’s day (February 19th, 2009). Finding a way to sell water to people as cures for their diseases is certainly entrepreneurial – but I see nothing honorable about it. I hope that President Gerbino sees the light before founder’s day.
December 2nd, 2008 by Dr. Val Jones in Book Reviews
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I just finished reading Dr. Ben Goldacre’s new book, Bad Science. It received a very favorable review by the British Medical Journal, and so I thought I’d take a look for myself. After all, I am passionate about patient empowerment and worry sincerely for their safety as healthcare is becoming more and more of a “do-it-yourself” proposition.
Ben is a talented writer – his style is straightforward, accessible, and witty. The premise of the book is to expose the underbelly of science – how it’s miscommunicated to the public (via media, PR, and representatives from the snake oil community) and how research is often poorly designed (by uneducated scientists and government agencies, for-profit pharmaceutical companies, and biased physicians).
The case studies presented in Bad Science are especially poignant. Ben has selected a few shining examples of self-promoting figures who have risen to the highest rank of “expert” in the eyes of the media – all the while referring to themselves as “doctor” and yet only having a Ph.D. from an online correspondence school. Their legal bully tactics, fabrication of data to support their proprietary health gimmick, and extreme narcicism – are excellent studies in poor character triumphing over common sense. It is painful to see how successful snake oil salesmen can be, even in these modern and “enlightened” times.
Bad Science carefully dismantles the pseudoscience that underlies many of the claims of alternative medicine. He clearly demonstrates how research can be manipulated to demonstrate a positive effect for any therapeutic intervention, and explains why cosmetic and nutrition research are particularly rife with false positive results.
Ben also explores the role of the human psyche in misunderstanding science. Our deep desire to find a 1:1 correlation between every cause and effect is difficult to overcome. We want 1) to bring artificial simplicity out of complexity, 2) a quick fix in a pill form, 3) to believe in “breakthrough therapies,”4) to read sensational or scintillating news headlines. Unfortunately, science is often coopted to pander to these wants, rather than illuminate the truth.
Finally, Bad Science explores the many ways that statistics can be manipulated to support any claim. In fact, human intuition about math in general is quite flawed, which works against us as we try to understand the data collected by researchers.
I finished the book feeling enlightened but somewhat despairing - yearning to read a sequel, “Good Science” if only to restore my hope in the idea that wise people will have the courage to seek truth over sensationalism, and value objectivity over subjectivity for the greater good of all.
What does Ben Goldacre think we can do to combat the tidal wave of bad science on the Internet? He suggests that people of sound mind blog about the subject as frequently as possible, so that those who are searching for a voice of reason may find one. I blog here and at sciencebasedmedicine.org for that very purpose.
In my next post, I’ll summarize some tips from Bad Science that will help you to recognize when a health message is likely to be inaccurate.
