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Why Non-Scientists Should Not Direct Scientific Efforts: Senator Harkin’s Misguided Beliefs 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

Philadelphia College of Pharmacy and Science Is Planning To Honor Quackery

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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.

How The Health Blogosphere Was Scammed

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In a press release dated January 28, 2009, the HealthCentral Network announced the acquisition of a company called Wellsphere from its young CEO, Ron Gutman. Many of my fellow medical bloggers are familiar with Wellsphere as they’ve received countless email form letters from Wellsphere’s CMIO, Dr. Geoffrey Rutledge. The form letters are flattering, and suggest that the company would like to feature the blogger’s writing on their platform.

But what happens next is disturbing – to become a member of Wellsphere, bloggers provide access to their blog’s RSS feed. Hidden in the fine print is the blogger’s consent for Wellsphere to publish the entire feed (in other words, all of the blogger’s written work) and that once it’s published on their site, they own the intellectual property rights to it.

Astonishingly Wellsphere convinced some 1700 bloggers to join their network, and have now sold their site (which is comprised almost entirely of blog post content) to HealthCentral Network for an undisclosed amount, likely in the millions.

How much did the bloggers get for their writing? As far as I know, zero dollars.

In the reference section below you will see copies of emails sent by Dr. Rutledge and excerpts from the website’s Terms of Use document.

Is this the biggest scam ever pulled on health bloggers? You decide. If you have any additional information, feel free to post it in the comments section below.

Addendum: HealthCentral Network CEO tells Wall Street Journal “most bloggers are happy about Wellsphere.” If you disagree, send protest Tweet #wellsphere or leave comment below.

References:

Here is the introductory form email sent out by Dr. Rutledge:

Hi Dr. Jones,

I was on a search for the best medical blogs, when I found you at X.  I think your blog is great. I’d like to invite you to participate in the network of medical expert bloggers at Wellsphere, but perhaps I should explain a bit about myself and about Wellsphere as background.

My name is Dr. Geoff Rutledge, and, like you, I understand the power of the Internet to help people. I’m a physician (board certified in IM and EM) who previously practiced, taught, and carried out research at Stanford and Harvard medical schools, before I built and launched the first consumer ehealth service that became WebMD.com.

I now work with Wellsphere, which is a next-generation online platform that helps people achieve their health and healthy living goals – it is a major advance in the way people find and share information and services. Our platform connects millions of users with the valuable insights and knowledge from health leaders and medical experts like you — take a look at how the platform works at www.wellsphere.com. Stanford University was so impressed that they deployed our service for the entire campus (see stanford.wellsphere.com). We sell our service to employers and health plans – you won’t see today any ads or commercial services on our free public site.

I offer you the opportunity to be a featured medical expert blogger for a new  Wellsphere community. Members and visitors will see your postings highlighted, featured, and clearly marked as authored by a true medical expert.

When you join, we will feature you on our medical experts page (here is the preliminary design for this page: http://www.wellsphere.com/medical-experts.htm), and I will highlight your participation and your postings in my personal blog, which is featured prominently on the homepage of wellsphere.com (Dr.Geoff’s MedBlog, http://medblog.wellsphere.com/).

We will republish the postings you’ve already written for you (through your RSS feed), and feature them not only on the community pages of the site, but also within a new dynamic magazine-like Wellsphere360 section, where we give users a comprehensive view of medical expert information, plus news, videos, local resources, and member postings on topics you write about. You can see a sample of a Wellsphere360 special section at http://www.wellsphere.com/Wellsphere360/diabetes-type-2.htm

Also, I will select the best medical bloggers to feature on our homepage at www.wellsphere.com.

Your posts will link back to your blog, so you will benefit from Wellsphere’s high ranking and large readership interested in your topic, which will give you more traffic, additional relevant audience, and a higher ranking for your blog. Wellsphere has well over a million visitors per month, and is growing rapidly.

If you would like us to feature you, just send me an email to Dr.Rutledge@wellsphere.com.

Good health,

Geoff

Geoffrey W. Rutledge MD, PhD
Dr.Rutledge@wellsphere.com
http://www.wellsphere.com


Here is a follow up email after I declined to join the network:

Hi Dr. Val,

We haven’t met, but I’ve been following your journey. We sent you an invitation to republish your blog from RevolutionHealth on Wellsphere, though I understood why that was somewhat problematic. I’m looking forward to seeing your new site at http://drvalblog.com/

Have you followed the advances that Wellsphere has made in creating a consumer-focused site that makes it easy to find both medical expert content and knowledge, and patient/community support?

If you would be interested in reaching the Wellsphere audience (now significantly exceeding that of RevolutionHealth, with over 2 million visitors per month), I would be pleased to extend the offer to republish your blog postings on Wellsphere.

We also could list you as a Notable Wellsite on topic pages of your interest (for which we ask only that you either list us on your blogroll, or take advantage of our free Health Knowledge Finder widget, or post an “I’m featured on Wellsphere” badge on your site.)

Cheers, Geoff

Here is a follow up email sent to a blogger who declined to join the network:

Hi XXX,
I just wanted to follow up on the invitation I sent you to be a featured blogger on Wellsphere.com. I was impressed with your blog at XXX, and invited you to be a featured blogger in the new General Medicine community.  We can also promote your blog in our new dynamic, magazine-like WellPages (with no extra work for you)! If you’re interested in being featured and promoting your blog to the larger Wellsphere audience, please drop me an email!
Good Health!
Geoff

Here is more information on how this works:

We republish your articles on our site, and include links back to your site. We also publish your profile with a link back to your site, and we feature you on special sections on topics that you write on, and in your topic-based community.

We will set up your profile if you don’t already have one, so you don’t have to do anything but give us permission to republish your content on our site. We don’t require a particular schedule for posting, though we have invited you to become a Wellsphere health blogger based in part on your history of posting on your blog.

Our growing network of bloggers (now over 1700) have told us they value what Wellsphere is trying to accomplish – helping people of all walks of life and across the spectrum of health to achieve healthier lives. They also appreciate the opportunity to reach the larger (and also rapidly growing!) Wellsphere audience, and to benefit from links in each posting that drive traffic back to their blogs.

We would be happy to include you in our network as we expand into health topics.
——
Geoffrey W. Rutledge MD, PhD
Chief Medical Information Officer
Wellsphere, Inc.
http://www.wellsphere.com

Here is an email from Wellsphere mistakenly sent to my webmaster (he’s not a blogger):

Hi john,

We are excited to recognize you in our new YES, WE CARE! Campaign that honors everyday heroes, like you, who put themselves on the front lines in the quest for a healthier, happier world by spending their time and putting their hearts and souls into helping others in need. We’re particularly excited to have this chance to honor you, for dedicating your time and writing to help people improve their health and well-being. We’ve nominated YOU as one of our Everyday Heroes!

As part of the YES, WE CARE! Campaign, we are creating a special video to highlight some of the amazing stories we’ve heard that demonstrate that caring for others is alive and well today all over the world. We would love to include YOUR story in the video! If you would like to send us a short video (cell phone or webcams are just fine!) about what moved you to start your blog, or to share a moving story of caring that you were involved in or heard about, we’d be happy to include it in the video. You can also interview someone you think is an Everyday Hero, or tell their story. Please keep the length of your video between 20 seconds and 2 minutes. The video can be very casual and definitely does NOT need to be professional or polished – just be yourself!

Please send us the video ASAP, and no later than Sunday, October 19th.

We can’t wait to see your videos and are looking forward to recognizing you and other Everyday Heroes you know for your extraordinary contribution to the world!

To submit your video, send us your video as an attachment via email to wecare@wellsphere.com. If you would like to send a video directly from your cell phone, just email me at Dr.Rutledge@wellsphere.com and I’ll send you the cell phone number you can send a video-text message to.

Good health!
Geoff

Geoffrey Rutledge MD, PhD
Chief Medical Information Officer
Wellsphere
Dr.Rutledge@wellsphere.com

Here is an email from Wellsphere about their plans for a health blog conference:

Hi ,

This week, I’m excited to share the warm words we’ve heard about all of you and the early feedback we’ve heard about the Yes, We Care Campaign, and announce the world’s first Health Blogger Conference!  We can’t wait to meet you in person…

Yes We Care!
The Yes We Care Campaign launched last week, and we’re thrilled to be able to honor you and your colleagues on the Map of Caring. The response has once again been quite dramatic. Many of you have already posted your Everyday Hero badges and the heartwarming Yes We Care! Video on your blogs. Here are a few of the comments we’ve heard about the campaign:

“I am thrilled to participate in your “YES, WE  CARE !” Campaign and am most humbled in your nomination.  What an amazing idea! Our blog continues with the hope of “paying it forward” and helping others, just as you are doing with Wellsphere. .. Thanks for doing such an amazing job!”  – http://www.ranaesheart.com/

“Thank you so much for recognizing my site and the effort that went into creating it!!! It’s amazing people like yourselves that keep me going and make a contribution to the greater good of all !! thank you again my friends !!!” -http://liftheavy.wordpress.com/

“Here is the video from Wellsphere! It is very cool it’s a 10 minute video with people from all over trying to help heal the world! Awesome video guys!”  http://thelifeofthomascslater.blogspot.com/
“I want to take this opportunity to thank Wellsphere for calling me a “Everyday Hero” for the lives I have touched. I want to say thank you for giving me that opportunity to do so.”  http://ucanhope2.blogspot.com

Many of you commented that the Yes We Care video let you see and connect with other members of the Health Bloggers Network for the first time, and asked if we would consider organizing an event for everyone to meet and connect with each other.  WHAT A GREAT IDEA!

I am very pleased to announce the world’s first Health Blogger Conference (“ HBC -09”)! This conference will be the largest gathering of health writers in history!  The Conference will be by invitation only, and as a member of the Health Blogger Network, you will automatically be guaranteed an invitation. This will be a great place for you to meet fellow health bloggers, share best practices, discuss sources of ideas, learn how to promote your blog, and meet some of the most prominent figures in the world of health. There will be a series of organized information sessions and seminars, as well as fun events and ample opportunities for you to meet and mingle in a relaxed atmosphere.   We will announce the location soon – somewhere you will enjoy a healthy, rejuvenating, experience.

If you’d like to get involved in the Conference, here are some of the opportunities available to you:
– become an organizer                                         
– become a volunteer
– give a talk or seminar
– organize a panel presentation
– suggest a topic for a talk or a panel
– suggest a speaker to invite to give a presentation

Here Are Excerpts From Wellsphere’s Terms of Service Document:

Ownership
…All Website Materials, including any intellectual property rights in such Website Materials, are the property of Wellsphere, its affiliates, licensors, or the designated owners, and are protected by applicable intellectual property laws. You should assume that everything you see on this Website is copyrighted unless otherwise noted, and may not be used without our written permission except as provided in these Terms…

Content You Submit to or Post on the Website
…You agree that any and all comments, information, photos, videos, feedback and ideas that you communicate to Wellsphere or submit or post to the Website or give Wellsphere permission to post to the Website (“User Materials”) will be deemed, at the time of communication to Wellsphere or submission or posting to the Website, to be the property of Wellsphere, and Wellsphere shall be entitled to full rights of ownership, including without limitation, the unrestricted right to use or disclose such User Materials in any form, medium or technology now known or later developed, and for any purpose, commercial or otherwise, without compensation to you. In the event that you have any rights in the User Materials that cannot be assigned or waived you hereby grant to Wellsphere a royalty-free, paid-up, exclusive, worldwide, irrevocable, perpetual license to (i) use, make, sell, offer to sell, have made, and further sublicense any such User Materials, and (ii) reproduce, distribute, create derivative works of, publicly perform and publicly display the User Materials in any medium or format, whether now known or later developed.

When you post your own copyrightable content on the Website or give Wellsphere permission to post your copyrightable content on the Website, you retain ownership of any copyright you claim to your submitted content. However, by posting your content or giving Wellsphere permission to post your content you automatically grant Wellsphere a royalty-free, paid-up, non-exclusive, worldwide, irrevocable, perpetual license to (i) use, make, sell, offer to sell, have made, and further sublicense any such User Materials, and (ii) reproduce, distribute, create derivative works of, publicly perform and publicly display the User Materials in any medium or format, whether now known or later developed…

When Did Diet And Exercise Become “Alternative Medicine?”

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The Wall Street Journal recently published an opinion piece written by Deepak Chopra, Andrew Weil, Dean Ornish, and Rustum Roy. Together they argue that Americans need to focus on healthy diet and exercise to prevent and reverse some of their diseases and conditions. This is obviously good advice – and an approach that mainstream medicine has been promoting for decades (well, technically millennia). What irks me is that they seem to suggest that this is “alternative medicine” that they (without help from the medical establishment) are fighting hard to have it included (or integrated) into general practice.

There is nothing “alternative” about healthy diet and exercise. This is mainstream, science-based medicine. The problem with Chopra and Weil is that they argue for obviously healthy behaviors and then integrate them with placebos (acupuncture and meditation have not been demonstrated to have value beyond their placebo effects) in some kind of guru’s proprietary recipe for good health.

Why not promote what has been shown to work – healthy diet and regular exercise – and leave out the placebo treatments? Why must “good health” be inexorably linked to specific culture-based practices? Why should people feel pressured to practice yoga, distract themselves with needles in their ears, or participate in Eastern meditation to be well? And why should Obama heed Chopra et al.’s call to: “make [alternative medicine practices] an integral part of his health plan as soon as possible.”

In this economy where budgets are stretched thin and healthcare service shortages are bound to worsen, the last thing we need to do is fund and promote placebo medicine. Rational people want to figure out which medical treatments and lifestyle behaviors are effective for preventive health and disease management – and focus exclusively on those interventions. It’s time to stop wasting money on scientifically-debunked therapies. We don’t have the luxury of paying for placebos like energy medicine, homeopathy, and acupuncture – let’s focus on the basics, beginning with eating healthy, portion-controlled food and getting regular exercise. That’s not alternative medicine. It’s just common sense.


The True Life of a Pediatric Blogger

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Not only am I welcoming in a new year, but also a new opportunity. This is my first blog on getbetterhealth.com, and I am very excited. I previously worked with Dr. Val at Revolution Health, where I was a pediatric consultant and blogger, and I now have the good fortune of working with her on her new health website.

I plan on blogging regularly and look forward to getting to know you better – your interests, questions, and goals. Actually, I would love to learn what you want from me and how I can best serve you. It might help if I first tell you about myself and my own interests. I am a pediatrician in private practice in Maryland. I am also a blogger, speaker and writer. I just finished my first book, “Anorexia,” for ABC-CLIO and recently wrote a story which will appear in a book about pediatricians, which is being edited by Dr. Perri Klass and published by Kaplan Publishing.

I love to teach. One of my favorite aspects of pediatrics is educating parents and kids, whether it’s about breastfeeding, asthma, puberty, or the latest clinical research. I love to travel and learn about new cultures. My late-husband and I spent three years working at the Kayenta Health Center on the Navajo Reservation, where we were constantly learning about health-related customs and decisions which were so different from our own.

And I love my children. I have two wonderful daughters (if I must say so myself), ages 13 and 10 years. I enjoy writing about them in my blogs occasionally. It hasn’t bothered them yet, but I assume I will soon have to be careful about what I divulge with regards to my teenager.

A very sad part of my life was the death of my incredible husband almost four years ago. He was diagnosed with a glioblastoma, a type of brain tumor, on his 40th birthday, and died exactly one year later. His illness and death were not only difficult for obvious reasons, but also because the location of the tumor caused significant personality changes and the loss of his ability to do every day things which we take for granted, such as motivating himself to stand up from a sitting position. I learned more than I ever wanted to know about the pitfalls of the health care system and how to look for clinical research trials. Since my husband became ill, I have been working on a book for children whose parents have cancer. I am determined to finish it.

I think that’s enough about me. Now I’d like to know about you. I want to know what your issues and concerns are, and what you would like me to discuss and blog about. Let’s make this year our best and most productive yet!

Stacy Beller Stryer, M.D., FAAP

 

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