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The Decade’s Top 5 Threats To Science In Medicine

As 2009 comes to an end, it seems that everyone is creating year-in-review lists. I thought I’d jump on the list band wagon and offer my purely subjective top 5 threats to rational thought in healthcare and medicine.

Of course, it strikes me as rather ironic that we’re having this discussion – who knew that medicine could be divorced from science in the first place? I thought the two went hand-in-hand, like a nice antigen and its receptor… and yet, here we are, on the verge of tremendous technological breakthroughs (thanks to advances in our understanding of molecular genetics, immunology, and biochemistry, etc.), faced with a growing number of people who prefer to resort to placebo-based remedies (such as heavy-metal laced herbs or vigorously shaken water) and Christian Science Prayer.

And so, without further ado, here’s my list of the top 5 threats to science in medicine for 2009 and beyond:

#1: Congress

Money is the most powerful gasoline that can be poured on the fire of pseudoscience. And thanks to Senator Tom Harkin, and a few merry enablers, there is now legislation in the Senate healthcare reform bill that would allocate tax dollars to disproven and unproven medical therapies. Healthcare providers recognized by CMS will include alternative medicine practitioners – many of whom can meet licensing requirements with online degrees from schools that do not teach actual science. They will be eligible to become primary care providers, use “doctor” in their self-designation, and do untold harm to patients nationwide through misdiagnosis and mistreatment.

Please refer to this post for detailed amendment language, and for goodness sake – call your congressman or woman and ask them to move to strike this language from the reconciled house and senate bills before it becomes law. Seriously. Go call them NOW.

#2:  Mainstream Media

For some reason, snake oil has captured the imagination of the mainstream media. Thanks to people like Oprah and the major news networks, there is a steady parade of pseudoscientific poppy cock being spoon fed to the public. And because of the lack of critical thinking taught in schools, Americans (on average) have a 6th grade understanding of medicine. They have a hard time distinguishing science from pseudoscience, and with the constant barrage of miracle cures, “scientific” breakthroughs, and conspiracy theories about anything that actually works (e.g. vaccines). They have become skeptical of science while often totally accepting of snake oil.

Before we become completely despairing of any sliver of health enlightenment reaching the public through mainstream media – let’s recall that 2009 brought us a handful of journalists willing to stand up for truth and critical thinking.Newsweek’s Weston Kosova, the Associated Press’ Marilynn MarchioneWired’s Amy WallaceChicago Tribune’s Trine Tsouderos, and The Washington Post’s Clive Thompson deserve praise and encouragement for standing up for science.

#3: Academic Medical Centers

Often referred to by David Gorski as “Quackademic” Medical Centers – there is a growing trend among these centers to accept endowments for “integrative” approaches to medical care. Because of the economic realities of decreasing healthcare reimbursements – these once proud defenders of science are now accepting money to “study” implausible and often disproven medical treatments because they’re trendy. Scientists at these centers are forced to look the other way while patients (who trust the center’s reputation that took tens of decades to build) are exposed to placebo medicine under the guise of “holistic” healthcare.

I believe that patients are crying out for compassionate care – for more time with their providers, more dignity in their choices, and more participation in their care. In my opinion, these needs can and should be met by science-based professionals who offer patients the truth about the strengths and limitations of their options – there is no need to fill this emotional need with false cures and placebo treatments, and spin it as if the patient is getting better “integrated” care. Quackademic medicine is neither compassionate nor scientifically honest. It’s just a complex new way of providing placebo care to patients who need some common human kindness.

#4: NCCAM

Even though we’ve invested $2.5 billion tax payer dollars and 10+ years of time on studying complementary and alternative medicines – we have discovered NO single breakthrough in medical treatment as a result. Not only does this Institute appear to be a real waste of scarce resources, but In fact, the TACT trial (in particular) offers a stark example of the unethical practices that can arise when vigorous scientific standards are not met. Thanks to Dr. Atwood’s diligent review, we have a clear understanding of the shenanigans at play:

The NIH approved a research study (called the TACT Trial – Trial to Assess Chelation Therapy – a supposed treatment for arteriosclerosis) in which the treatment had no evidence for potential benefit, and clear evidence of potential harm – and even the risk of death. Amazingly, the researchers neglected to mention this risk in their informed consent document. The NIH awarded $30 million of our tax dollars to ~100 researchers to enroll 2000 patients in this risky study (ongoing from 2003-present). Even more astounding is the fact that several of the researchers have been disciplined for substandard practices by state medical boards; several have been involved in insurance fraud; at least 3 are convicted felons.

Many have called for defunding the NCCAM, and that certainly seems like a reasonable request under the circumstances of such a low ROI and ethical breaches.

#5: New Media

Just as mainstream media is beginning to fade in its influence and popularity, online and “new” media are making exponential leaps in influence.  The Huffington Post and Age Of Autism are two strongholds of health misinformation that come to mind. Of course, “user generated content” and unvetted health advice and claims are easily made by anyone anytime. And thanks to the magic of Google, a health claim need only be popular to be promoted. Truth, accuracy, and scientific rigor aren’t always rewarded in this brave new world of digital influence. Being right has been uncoupled from being influential. The “wisdom of crowds” now decides what people see first when they attempt to educate themselves about health matters.

And so, dear readers of Science-Based Medicine, we face formidable foes in our quest for honesty and integrity in medicine. I predict that the next decade will favor the organized, not the accurate. And so with that in mind, let us strive towards building our network of critical thinkers (in the government, media, research and clinical centers, and online), organizing our efforts to promote science and rational thought. We’ll each need to channel our inner “community organizer” to counter the pseudoscience movement. And we can win this, because in the end…

Science works.

*This blog post was originally published at Science-Based Medicine*


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9 Responses to “The Decade’s Top 5 Threats To Science In Medicine”

  1. Tony S says:

    Nice post! Let me add one:

    #6: Jenny McCarthy

  2. Robert says:

    I’m glad you have Congress at #1.

    The media, though, can sometimes provide helpful information. I learned about adrenal fatigue through “new” media when I was repeatedly told by doctors that my exhaustion was caused by sleep apnea, narcolepsy, stress, sinus infections and a litany of other misdiagnoses. I’m not saying we should dump doctors altogether in favor of WedMD or Twitter, but it CAN provide useful information from time to time.

  3. drcharles says:

    Great post and call to arms! A rigorous grounding in science during schooling would be a great investment in critical thinking for life.

  4. Val, as you state, we are not operating in a sea of science, but are wallowing in ‘wellness’. It’s amazing how many folks are paying hard cash for stuff that has never been tested, and likely doesn’t work. (At least with respect to Christian Science, at least prayer has been actually studied!) In my own field of GI,patients (at least those who admit it) tell me that they regularly undergo ‘high colonics’ to rid themselves of dreaded internal toxins. Reiki, magnetism, homeopathy, naturopathy and other versions of black magic are other players on the scene. We should keep in mind, however, that it’s not just the snake oil salesmen who are responsible for pseudomedicine. The public demands it. The antidote to quackery is education.

  5. drval says:

    Great points, Michael. Education is certainly the antidote! :)

  6. Mike Clark says:

    “…thanks to the magic of Google, a health claim need only be popular to be promoted. Truth, accuracy, and scientific rigor aren’t always rewarded in this brave new world of digital influence. Being right has been uncoupled from being influential. The “wisdom of crowds” now decides what people see first when they attempt to educate themselves about health matters.”

    So well said… the blah blah blogosphere and mad clicking of 12-year-olds so completely dominate the search results you see in google that science, reason and diligent research are buried. This does not only apply to health care, by the way…

    Mike

  7. Ben Kavoussi says:

    This is an excellent and well-written post that summarizes everything that is wrong with “alternative” medicine. And I am glad that you mention that new Digital-Age paradigms, such as the “wisdom of crowds.” These paradigms are being used out of context by people who do not really understand them as a justification for clinical nonsense. Remember, collective thinking is what has created magical thinking, mythologies, astrology and now “alternative” science and medicine, and is actually something we want to shy away from as scientists.

  8. Dear Dr. Val,

    I suggest that we should demand rigorous scientific proof of the efficacy and safety of ALL the therapies that we physicians employ. This includes conventional as well as complementary/alternative medicine (CAM). Your article implies that conventional medicine is grounded in evidence-based research and that CAM is not. This is grossly overstated, and suggests that a double standard is being applied to these fields. Consider:

    Of the 2,404 conventional therapies recently assessed by the Clinical Evidence initiative of the British Medical Journal, only 15% were rated as clearly “beneficial,” and 22% were rated as “likely to be beneficial.” Sixteen percent were judged to be either ineffective or harmful, unlikely to be beneficial, or a trade-off between benefit and harm. The largest category, 47%, was rated as “unknown effectiveness.” See: http://clinicalevidence.bmj.com/ceweb/about/knowledge.jsp.

    Epidemiologist Barbara Starfield, of the Johns Hopkins School of Medicine, reported in 2000 that around 225,000 deaths occur annually in American hospitals due to the adverse effects of medications, infections, and errors, making hospital care the third leading cause of death in the United States, behind heart disease and cancer. [Barbara Starfield, “Is U.S. health really the best in the world?” Journal of the American Medical Association. 2000; 284 (4): 483-485]. These findings have become part of the national conversation in the United States, following the Institute of Medicine’s startling 2000 report, “To Err is Human” [L. T. Kohn et al, To Err is Human: Building a Safer Health System. Washington, DC: National Academies Press; 2000].

    These dismal findings are not new. Richard Smith, editor of the British Medical Journal, observed in 1999, “[O]nly about 15% of medical interventions are supported by solid scientific evidence….This partly because only 1% of the articles in medical journals are scientifically sound and partly because many treatments have never been assessed at all” [“Where is the wisdom…! British Medical Journal. 1991;303:798-799].

    David A. Grimes, of UC-San Francisco School of Medicine, writing in the Journal of the American Medical Association in 1993, said, “Much, if not most, of contemporary medical practice still lacks a scientific foundation” [“Technology follies. Journal of the American Medical Association; 1993; 269(23): 3030-3033].

    As early as 1978, the Congressional Office of Technology Assessment found that only an estimated 10 to 20% of the techniques that physicians use are empirically proven [Assessing the Efficacy and Safety of Medical Technologies. Washington, DC: Congressional Office of Technology Assessment; 1978:7].

    Dr. Brian Berman, of the University of Maryland School of Medicine, examined a random subset of 159 out of 326 completed Cochrane reviews of conventional medical practices. Overall, the “positive” and “possibly positive” reviews totaled 38.4%, while the “no evidence of effect” and “negative effect” totaled an alarming 61.6% [J. Ezzo, et al, “Reviewing the reviews: How strong is the evidence? How clear the conclusions?” International J. Technol. Access in Health Care. 2001; 17(4): 457-466].

    Overwhelming evidence reveals that conventional medicine is, on the whole, woefully unscientific. It’s fashionable and easy to deny this, but the facts say otherwise. So, by all means, Dr. Val, be critical of CAM – but do not fall into a double standard. Let us ruthlessly apply science to ALL we do as physicians. Let us challenge ALL areas of medicine to a higher standard. On that, I’m pretty sure we can agree.

    Keep up the good work.

    Sincerely yours,

    Larry Dossey, MD

  9. Cindy Koestler says:

    Dear Dr. Val Jones:
    How interesting your 5 top reasons are for not wanting CAM involvement in healthcare. You say we basically are a bunch of 6 grade educated people, yet we study the body and all the working organs, celluar structure, bones and all things that have to do with the science of health. The natural things we suggest for people are the very base of medicine that you prescribe to your patients. Last time I checked botany was a science, so was anatomy, psychology and all the other so called non-science classes you say we do not understand. You sir are the very reason people are looking for alternative ways. The phamacutical companies are running rampid with so called medicine that is actually killing people. Do you study that sir? You say our ways kill people, yes there are plants that are dangerous the way you know that is by studying the consituents in those plants and knowing and recommending the correct dosage for those plants or oils. We are taught all of these things in those online classes from a very long standing and reputable school. I am a student of CAM and the reason I wanted to learn it is because I am tired of a doctor prescribing me medicine as a test to see if it will actually help me. With cancer raging in the United States, obesity, heart problems, bone problems and all the other diseases such as the flu and the simple cold, herpes virus,and the many other diseases there is real need for Alternative Medicine in our lives. We hope for the natural cure of life Holistic Medicine is a great thing perhaps you should try it.

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