quackademia

Homeopathy

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I think this widespread attraction that CAM has for many people is a reflection of their innate desire for mystical and eerie experiences. Since science/evidence-based medicine doesn’t admit magic or defer to wishful thinking, and much of it is understood mechanistically, it’s just plain boring. So it has to be sexed up with an assortment of zesty wow factors. For example, just look at how often CAM abducts the term “quantum” from physics and mangles it into some zany quasi-explanation. After all, “quantum” is ripe for such picking because even physicists themselves highlight the subject’s puzzling aspects and admit that nobody really understands it.

The difference is that those of a scientific bent view such mystery as a challenge, not as something to be emulated or, worse, to be opportunely invoked for the bedazzlement of spectators.

I’ve been reading you forever and am a devoted skeptic, BUT, as someone who has developed a number of minor, but chronic “issues” (mostly related to aging it seems) and getting nothing but shrugs or “see a psychiatrist”, I do think that the profession is not doing enough to offer something better. I can certainly see why the less-informed, more believer-oriented turn to these so-called alternatives. Sometimes I which I were not informed enough to know better, because I’m just left on my own to try to sort this out with an endless-seeming quest for a primary provider who can help me sythesize some sort of approach--I had one once, but then moved. BTW, I saw the shrink, who had no more to offer than the others.

wish, not which

"no matter how much each new example of quackademic medicine depresses me"

Chin up Orac, I do believe that the UK has ceased to offer naturopath degree programs:

Ok there's one, but it's actually named "Herbal Medicine BSc Honours " .No homeopathy there.

Does the timeline for the Helpsy owner make sense to anyone? Supposedly, this woman, 10 years ago, was a "busy software engineer". So, within 10 years, she got an RN/BSN, worked at Mayo, Stanford and UCSF as a cancer nurse and started her own business? Something seems weird here.

@ MI Dawn--there's all sorts of nonsense out there. From an alumni mag of a place I went that should know better but does not (they glamorized their alumnus who started that rathole of naturopathy--Bastyr University--a few years back) comes this nugget of nonsense from a more recent edition (this year) of their alumni magazine article about someone I went to school with who ditched a lot of scientific training for a masters in psychology along with this rubbish:

"[The]NeuroAffective Relational Model (NARM), forms the basis of XXXX's private practice. NARM emphasizes self-regulation and working in the present moment, and XXXXX defines it as a “resource-oriented, non-regressive model [that] emphasizes helping clients establish connection to the parts of self that are organized, coherent and functional.”

“The most important piece here is that we’re all physiologically wired to move toward aliveness. So I really encourage everyone to keep listening to that inner voice and trust that you can overcome any limitation you encounter and to find people who can help, because we’re out there,”

“You don’t have to know what the outcome is going to look like or even the exact path. It’s just one foot in front of the other and trusting that basic aliveness.”

If you can make sense of any of that rubbish, please let me know. The pushers of woo and snake oil today have a bigger thesaurus and even less shame.

Sorry, Dr Hickie! I have an infallable test for woo and nonsense: if my brain stops working and my eyes glaze over from teh stupidz, I know it's woo. I didn't even make it through your first italicized paragraph!

“You don’t have to know what the outcome is going to look like or even the exact path. It’s just one foot in front of the other and trusting that basic aliveness.”

...right off the edge of that cliff.

MI Dawn@5: My reaction to the mention of possible spinal surgery was that there is something in Ms. Agarawal's medical history that we're not being told. Recommendations for spinal surgery don't come out of the blue like that. Something was causing her back pain--whether it was an auto accident, a slip and fall, too much heavy lifting, or some ergonomic issue in the workplace, we aren't told. That's the thing which makes the timeline you point out implausible. A healthy, ambitious person might accomplish all of that in ten years, particularly the part about starting her own company (she would be using skills she acquired during her previous career as a software engineer). To do all of that while dealing with back pain severe enough to contemplate surgery is a lot harder.

NeuroAffective Relational Model (NARM)

Did you make that up, Dr. Hickie, or is that actually the acronym that your fellow university alumnus uses? Poe's Law is very much in force here, so I honestly can't tell.

I work in a field where people frequently get cute with acronyms. For instance, a now-defunct NASA online proposal system actually had the acronym SYS-EYFUS, where the last five letters were supposedly derived from NASA mail codes for the divisions involved. If you are familiar with the Greek mythological character Sisyphus, you will immediately recognize the similarity to the lifestyle of a soft money scientist.

"The splash page portrays a woman, her hands raised, looking out over a beautiful hilly countryside. What is it about “integrative medicine” that it always—and I mean always—features images like this"

It is the naturalistic fallacy at the core of many of these quackeries. That if only we got rid of man made things and instead were more of a part of nature, then all would be healed. From organic to homeopathy to naturopathy (it is in the name itself) the underlying belief is that man made things are bad and nature is good.

#6 Chris Hickie

Hey watch the psych cracks :) Dr Oz is not a psychologist.

NeuroAffective Relational Model

If you can make sense of any of that rubbish, please let me know.

Easy, it says, “ I may be an fraud and/or an idiot but give me money anyway”

@ Eric Lund #9 and MI Dawn #5
Yeah, there is something not being made clear. Before my wife was diagnosed with MS, her symptoms of leg pain, numbness and weird nerve sensations were blamed on possible disc problems and surgery was suggested as a fix. She passed on it as the cure seemed more extreme than the condition at the time.
In the early stages, as it comes and goes, it is easy to attribute success to random interventions, until eventually the downs outnumber the ups.
Who knows what Sanjeeta may have and how long it will respond to her wellness strategy.

@ jrkrideau
My favourite is Applied Psycho-Neurobiology.
"Trauma is an experience that cannot be digested. Epigenetics is the load of the system from the family tree and from your soul history, and from the early years, and the 9 months in the womb. It leaves an imprint that permanently changes our physiology and behavior and everything else."
We are taking orders for the new UV Mirror that detects "unwelcomed spirits", Turquoise Mercury Photon Pulser and Energetic Detox Kits"
The above is from the helpful website, unfortunately my SIL believes this guy is the real deal.

I saw this announcement posted at a university health clinic last week:

The University of New Mexico
Health Sciences Center
Brain-Centered Therapy versus Medication for Urgency Urinary Incontinence and RCT (Hypnotherapy or Pharmacotherapy-Hyp-hOP )
Yuko Komesu, MD

Do you suffer from Overactive Bladder….
UNM Urogynecology has a study opportunity for women with Urge Urinary Incontinence…
If you are over the age of 18, you may qualify for a research study to find out if Medication or hypnotherapy can help.
You may be eligible for free medication or hypnotherapy

Contact Urogyn Research for more details….

Stanford! Say it ain't so? I went down the rabbit hole of links provided by Orac and the cowpie could have choked me.
In northern California, it was just the corner quack-in-a-box but now the quacks are really making inroads into otherwise respectable institutions. Dr Speigle, Dr Maizes and Helpsy, Oh Jesus.
I am a pro patient seven years and counting. Post stem cell transplant patients like me have left cancer behind but with GVHD, we are the step children of the hem/onc clinic. I am at UCSF not far from Stanford, I would seem to be the perfect client for Helpsy. If they ever approach me they are sure to get a raft of negative about all of their positivity crap. What they really mean is, being negative means not being positive about their stupid integrative approach. It's like, if you don't believe, you'll get cancer ....and go to hell too.
I have a sharp eye for stuff like that at the UCSF clinic. So far there are only a few fliers and brochures offering mildly woo stuff but so far nothing as bad as acupuncture.
I looked at the Stanford primary care physicians and chose alternative in the drop down menu and came up with two PCPs who also offered acupuncture. I wonder what the insurance code number is for that?

Oh No. I searched at UCSF just now and they also offer integrative medicine with seven PCPs available.

If you can make sense of any of that rubbish, please let me know.

I was able to form a vague notion of where they're coming from, word salad aside. The introduction to Heller's book is available. The blab level isn't quite as bad. What's it's like in practice, I have no idea – Denice would be the authority here.

^ Skimming a bit further, though, it looks like Heller is trying to have it both ways with the relevance of childhood experience – we consider your childhood rather than where you are now only to the extent that it can be banged into this framework.

I looked at the Stanford primary care physicians and chose alternative in the drop down menu and came up with two PCPs who also offered acupuncture. I wonder what the insurance code number is for that?

Without anesthesia? The ICD-10-PCS one is 8E0H30. I'm only getting S8930, "electrical stimulation of auricular acupuncture points," from easy HCPCS searches; feel free to do it the hard way.

What I can only guess are current CPT codes are, e.g., here.

Face it. You've lost. The only thing to do now is invent your own Orac Protocol for detoxification, whole-body wellness, and casting out demons.

I think this widespread attraction that CAM has for many people is a reflection of their innate desire for mystical and eerie experiences.

And at the same time, Americans are moving steadily away from churches. There's some kind of paradox
here.

So much of what quackademic medical centers embrace and investigate is tooth fairy science:

Well, at least we aren't talking about the tobacco science of the vaccine industry. People don't get autism from accupuncture you know.

Chris @6: Is that the same issues as the one with my friend the CRISPR guy? Or from before that?

When I told a fellow alum about the whole Bastyr thing I thought I would finally witness spontaneous human combustion, he was so pissed.

"Move toward aliveness" - uh, no, if you didn't sleep through all of freshman chem and physics you'd remember we're all moving towards death. Hello entropy!

(grumble grumble letting down the good name of my school that no one has ever heard of grumble grumble)

Shay @22: Maybe it's like the "spiritualism" craze of the Victorian/Edwardian period, which also saw tremendous technological and scientific advances?

Except instead of sitting around a seance table waiting for dear dead Aunt Melba to play the tambourine we're hanging crystals in the window to cure our eczema.

# 13 JDK
Amazing.
Applied Psycho-Neurobiology
http://www.holisticmd.org/treatments/applied-psycho-neurobiology/
It utilizes psychokinesiology (biofeedback-guided counseling and healing), understanding about color, eye movements (EMDR), energetic taping techniques (MFT), understanding about acupuncture, and unresolved emotions connected to acupuncture.

One does not see that level of inspired sciency baffle-gab very often. It must do more than just lighten wallets.

#6 Dr Hickie
I think it was the sentence about us being physiologically wired to move to aliveness (is that even a word?) that got me. After all we would have not moved very far along the evolutionary path if we were physiologically wired to move to deadness.

jrkrideau @25: understanding about color ? How does that even work? "You're an autumn who has issues with your mother, so I'll be stabbing you in this acupuncture point here."

Oh boy. UCSF has the "Osher Center for Integrative Medicine". They have integrative oncologists too. I am attending a biannual reunion of UCSF Bone Marrow Transplant survivors coming up. We get to hang with our doctors and caretakers for an afternoon. I wonder if a rep from the Osher center will be there?
I wasn't there, but in 2012 at the reunion, Rob Schneider was there for some reason. WTF. He is invested somehow. I wonder if he'll be there this time?

# 26 JustaTech

understanding about color ? How does that even work?

How would I know? I doubt the copywriter (err, doctor) knows.

I suspect it works very similarly to dealing withunresolved emotions connected to acupuncture. That is to say it does not. Well, unless you really, really BELIEVE.

Note the same site also offers homeopathic bee venom therapy. Steven Novella's review is not wildly favourable.

Mike Callahan, you wouldn't happen to be a time-traveling bar owner, would you?

CAM is everywhere in the Bay area. I was super confused to find several acupuncturists (some of whom were also MDs) in my public health program at UC (redacted). Like, why would people who are super into woo want a degree that's all math and policy and the greater good, rather than one-on-one patient interactions? I still have no idea.

redacted==Davis?

https://upload.wikimedia.org/wikipedia/en/6/64/Uc_Davis_Pepper_Spray_In…

http://www.occupythegame.com/casually_pepper_spraying_cop992.jpg

http://www.occupythegame.com/casually_pepper_spraying_cop92.jpg

Ohh, the humanity.

It seems to me "Helpsy" is a perfect name for this service.. It's like Stephen Colbert's "truthiness." It SOUNDS helpful, but really isn't.

energetic taping techniques

Applying tape here! And there! And I'll pull on it really hard! Wow, this is so exciting! Let's jump up and down a bit and then then we'll see what else we can tape!

I kid everybody not--the start of the article on this person who does this "NARM" is just as bad, and this alumni mag is from one of the highest rated undergraduate engineering/science colleges in the US . At the start of this article, this person rails on about having been a chemist but "got a look inside 'big pharma'" and changed her mind:

But XXXX quelled the thought, went on to earn her master’s degree in chemistry and landed a great job at a well-funded startup doing cutting-edge drug discovery research in a fast-paced, energetic environment. She went on to work in the biotech industry—doing research, overseeing operations and then consulting—for more than a decade. But when she got a look inside of “big pharma,” that unsettled feeling returned. She decided it was time to do something that could affect people’s lives in a more immediate way. Time for a career, she says, that “fit the deeper me.”

“I love science. I absolutely love research. So when I found Somatic Experiencing and the NeuroAffective Relational Model, I knew I had found something really important,” says XXXX. She returned to school and earned a master’s degree in psychology, became a Somatic Experiencing practitioner and trained in the NeuroAffective Relational Model.

Whatever she claims she's doing has no real research/backing to it. Lots of big words, though.

Also, not only is Stanford into quackademia in adult medicine, but here's a CME brochure I received about a meething they are hosting for quackademia in pediatrics: http://www.stanfordchildrens.org/content-public/pdf/cme-brochures/integ…

@ MI Dawn #5: actually, the timeline does work. She could have gotten her ADN in two years, plus one year for an online BSN or just gotten a BSN from a four year school. Then six years practicing at the hospitals mentioned is very plausible before quitting to start her own business.

The BUSINESS is bullshit, but the educational path is not. You can learn a hell of a lot in six years of nursing practice.

@JustaTech #24: To hell with freshman chem and physics, what about freshman ENGLISH?

Aliveness is not a word you'd find in any reputable dictionary. Don't even get me started on the non-sequiturs.

@ JustaTech #24--yeah, it's the place you and I went to for undergrad. Pretty sad that they let crap like this run in their alum mag next to people doing real science. You can find the article online for this NARM alum and also the one for the Bastyr alum.

I'm not surprised. For years Stanford has been offering dubious classes to the staff as part of the health improvement program.

See http://med.stanford.edu/content/dam/sm/hip/documents/HLAtAGlance.pdf

As usual they have their classes in Reiki healing.

A major problem is that given the known unscientific stuff, it is tricky to tell which classes have a scientific base. At least we don't have the Tibetan eye exercise classes anymore.

Anyone for Feldenkrais? Omada? Lantern?

After all we would have not moved very far along the evolutionary path if we were physiologically wired to move to deadness.

Some of us do seem to have that albatross around our necks; an evolutionary dead end, I suppose.

And at the same time, Americans are moving steadily away from churches. There’s some kind of paradox
here.

Well, churches are for boring, normal, ordinary people, like your mother and grandmother. Special-snowflake mystical woo experiences are for, well, special snowflakes. And they don't even have to make the effort to cook something for the church dinner. (Or the at-home potluck at a brother or sister's house if you're a Jehovah's Witness like my mom.)

I think it was the sentence about us being physiologically wired to move to aliveness (is that even a word?) that got me.

Meh. It's childish language, but it's not unimaginable that one would seek out a therapist for what are effectively feelings of death in life.

Like I said, I have no idea what it's like in practice. I didn't read the whole G—le books introduction, either.

^ Then again, that suggests a hydraulic model in which the "wiring" has lost conductivity,* or something. I think it's rather safe to assume that this is not snazzm-oriented, so, yah, if one can identify, say, maladaptive habits, the usual approach can be dragged out sessionwise with memory spelunking.

* Am I the only one who remembers the tabletop card game "Waterworks"?

energetic taping techniques
Ah, duct tape. Is there nothing it can't do?

Ah, duct tape. Is there nothing it can’t do?

I have found the quality of these tapes to vary widely, particularly in terms of withstanding repeated laundering.

@#1
I say that the widespread attraction to CAM stems from the miserable failure of modern medicine to cure anything significant besides a bacterial infection.

Synthetic chemicals do not have a good track record for healing disease.

shay simmons, #22:

“And at the same time, Americans are moving steadily away from churches. There’s some kind of paradox here.”

This isn’t necessarily a paradox because declining church attendance may be prompted by various other factors rather than waning desire for numinous experience. Nor is the desire for such experience necessarily the primary driver of church attendance. The burgeoning popularity of assorted irrationalities that characterise contemporary human history suggests that these are more attractive substitutes for formal religion. One important specific effect that Reiss neglects in his article is that of technological advances, in particular those related to the Internet, communication and the rise of social media, which combine to facilitate both awareness of alternatives as well as community from the comfort of an armchair at home.

Hi Orac

Is there evidence of academics and physicians having their careers damaged by resisting this tide of nonsense? Can physicians in the quackademically infected institutions freely refuse to co-operate and counsel patients against pursuing the quackery that the institution offers?

"And at the same time, Americans are moving steadily away from churches. There’s some kind of paradox here.”

"When men choose not to believe in God, they do not thereafter believe in nothing, they then become capable of believing in anything."
G.K. Chesterton

@ JP

Some of us do seem to have that albatross around our necks; an evolutionary dead end, I suppose.

The size of the bird could vary greatly, but many of us carry one.
Like many other commenters, the sentence "being physiologically wired to move to aliveness" made me cringe.
It's nothing more than an iteration of the "listen to your guts' instinct". There was a fad diet based on this. But for most of us simple clods, it's useless and guild-inducing garbage.

If I was "physiologically wired to move to aliveness", I wouldn't have eaten that second slice of pizza (or was it the third one?).

I mean guilt, not guild.

Oh, well, alt-med aphorisms are indeed meant to induce you to join the guild, or cult, or whatever.

@Panacea: The timeline - along with the fact that whatever was going on with her had suck severe back issues as noted above - still doesn't make a lot of sense. Nursing requires a lot of physical activity, especially as a student.

But let's work the timeline, pretending she didn't have back issues AND had all the courses needed within the required timelines for an accelerated RN program:

12-18 months to get her RN/BSN
1+years on a regular medical/surgical floor (most hospitals won't hire directly for specialty units like cancer treatment)
6 1/2 years as an oncology nurse, in 3 different hospitals. I can see the move from Mayo to Stanford (different states), but the move from Stanford to UCSF is interesting.

I just think her knowledge is very superficial, especially since she went full woo. Though as we all know to our sadness, WAY too many hospitals are offering woo along with standard care.

@Mark DePaun: you're as likely to get autism from acupuncture as from any other sham treatment or actual medical treatment. How many times must you be told that autism is a inborn DEVELOPMENTAL DELAY, not a disease you can "catch".

And at the same time, Americans are moving steadily away from churches. There’s some kind of paradox
here.

Nothing paradoxical about it. Most people who go to church (at least in the US) do so for the social community. Many people, particularly millennials but I am also among them, find that they would prefer not to be part of the community the church is offering. The subset of that group that still has unmet spiritual needs is likely to be woo-prone. And being a churchgoer does not make one immune; on the contrary, Orac has profiled many woo promoters who are also religious nuts.

Hi Dawn #50: I did overlook the back issues. Though even that wouldn't necessarily be much of a barrier, especially if she went to a community college. The open access nature of community colleges makes it very difficult for programs to eliminate students who have physical challenges. One of my former students actually had bilateral total knee replacements while a student (in fairness to her, she's a good nurse). Another student entered our program on a portable oxygen tank because her COPD was so bad (she passed away before she could finish the program).

But her knowledge isn't necessarily superficial because she went full woo. I know some very well educated nurses who understand the scientific method who are very into the woo. Nursing (my profession) seems to attract woo like moth to a flame; a lot of my colleagues buy into it. I suppose it's the touchy feeley aspects of nursing culture that make it attractive.

Like Orac, there were aspects of alt med that I thought might actually have some basis or merit to them, like acupuncture. I also thought there might be something to essential oils. So I gave it a chance to show me the evidence. Consistently, they fail. So I'm pretty much done with it. But many of my colleagues are not, and be it EBM on vaccinations, "Lyme Literate doctors", accupuncture, and so on, they just buy into stuff.

It's very frustrating.

Narad, I have indeed run into that nonsense previously

HOWEVER it was a long time ago and after a while, I have trouble recalling pertinent details because all of this crap sounds the same:
they find a well known theory ( Freud, Erikson, whomsoever) and blend it with nearly equal parts of Standard Woo ( frequent of the eastern variety- chi etc).

Usually some sort of hydraulic release to free up the frozen/ stuck parts is required.

And we all know what hydraulic release means
Use your imagination

At that, I must depart because my break is over.

Hello JP!
Glad to know you're around the ranch ( or whatever we're calling RI these days)

@Con-Tester

For example, just look at how often CAM abducts the term “quantum” from physics and mangles it into some zany quasi-explanation. After all, “quantum” is ripe for such picking because even physicists themselves highlight the subject’s puzzling aspects and admit that nobody really understands it.

As a physicist, I think that's an incredibly misleading statement. You have to remember that the way collaborative science is done, people have to talk to one another about pieces of information that don't quite fit in with the collective understanding. We pretty much always have to talk about what we don't understand, or else we would actually be talking about something that isn't scientifically interesting. This is the same as saying that because biologists are always talking about the puzzling aspects of evolution that the subject is ripe for abduction by cranks, or that because health science professionals are always talking about the puzzling aspects of vaccine science that antivaxxers are bound to catch on to their confusion.

I think that a big part of the reason that quantum gets abducted by cranks is because there are some very famous existential statements that have been made by equally famous scientists regarding quantum mechanics. It all boils down to an argument by authority. The problem is that the scale of these statements gets badly twisted when they are taken out of the context that generated them. And, naturally, nobody but physicists ever bother to spend time learning how those scaling arguments actually work. As such, every time popular culture naively generates an ansible or a teleportation device or something, people who don't know the machineries of quantum mechanics can coopt what that famous scientist said out of context as if that validates whatever crap they're talking about. A big part of the problem is therefore how people who don't actually understand the topic treat it when they're presenting what little they know to others. It's basically just a big game of 'telephone.' It pisses me off every time I read some Tech-press article about how 'quantum computing is about to change everything' because the zing words assure that the laymen are bound to misunderstand the science in favor of the fanciful image cast by the idiot journalist who was going for click-bait --nobody can possibly be surprised when people reading the article take that second hand piece of crap as gospel truth.

Yeah, physicists don't understand some parts of quantum mechanics, but that's overlooking exactly how much of it we do understand.

A quick post-script to comment #55 since I think it doesn't quite encapsulate my objection. The comment I was responding to is not a poor comment by any means.

I just don't think it's fair to single out quantum mechanics when cranks justify misrepresenting all sciences because no science is quite 'totally' understood. None of us can afford to -not- talk about what isn't understood in our respective fields and physicists aren't specially encouraging anybody by what we say. The cranks would seize on no matter what anybody does, and they seize on to everything!

After all, “quantum” is ripe for such picking because even physicists themselves highlight the subject’s puzzling aspects and admit that nobody really understands it.

I am also a physicist by training, and while I think viggen is going a bit hard here, this statement is indeed not fully accurate. It's not that quantum mechanics is puzzling and nobody really understands it. Lots of people do understand it and make a good living doing detailed calculations with it. The issue is more that quantum systems frequently work in ways that violate the intuition of people whose experience is entirely based on macroscopic systems. For instance, the concept that the act of measuring something can change the thing you are measuring. This concept derives from the Heisenberg Uncertainty Principle: there is a hard limit to how well you can simultaneously know the position and momentum of something, and any attempt to improve the precision of one of those variables beyond that point will reduce the precision of the other (e.g., to measure the position of an electron to picometer precision you have to whack it with a photon so energetic that it will knock your electron to kingdom come). That's why charlatans talk about quantum woo: lots of handwaving and "of course you don't understand this, because it doesn't work the way you expect it to."

The big difference between quantum physics (and chemistry and engineering) and quantum woo is that with a quantum physical system, you can make a detailed prediction of how your system will behave, and do detailed experiments that demonstrate that your system actually does behave that way (in some cases, to ten decimal places or more). Quantum woo can't do this, because if the experiment can be performed at all, it can only be performed once (on you, the subject).

Chris @37: To amuse myself I imagine these quacked-out alumns being dragged into a Star-Chamber-esque room before a hooded panel and being told, "Look at what we have given you, the education, the knowledge to do great things. And *this* is you repay us? You spit upon this illustrious institution! You are cast out!"
And then the alum is dragged off, stage left.

This doesn't count as quackademic medicine (more like wooful community medicine), but a certain hospital system in my area is sponsoring a "wellness symposium" for physicians and staff. It will feature talks such as "Go With The Flow" and "Don't Try To Be Mindful" (along with an optional "Mindful Walk").*

The scheduled speakers include one RN and a bevy of people with odd-sounding degrees (I am afraid to find out what an E-RYT-500 is).

*"Hey! Mind you don't step in that pile of raccoon feces!"

@ Eric Lund #57 --by chance did you major in physics at a college whose name rhymes with dud?

I know Eric from meatspace. He did his undergrad at a school whose initials spell the German word for "with".

plaindrom: Ah, those folks. Far away enough to not be rivals but friends.

Chris Hickie -- Are you thinking by any chance of a school whose first name is shared by an imaginary giant rabbit?

Tradition acupuncture was much different. Before the practice was modernized, needles of different metals were used. Each metal has its own reduction potential, and in this way, microcurrents could be induced.

This concept derives from the Heisenberg Uncertainty Principle: there is a hard limit to how well you can simultaneously know the position and momentum of something, and any attempt to improve the precision of one of those variables beyond that point will reduce the precision of the other (e.g., to measure the position of an electron to picometer precision you have to whack it with a photon so energetic that it will knock your electron to kingdom come).

May I OCD use avoidance in the face of anxiety grumble at bit? That's just the Compton effect; although that example was presented early on, the uncertainty princple is epistemological: noncommuting observables just don't have simultaneous eigenstates.

The whole measuremment-as-disturbance thing seems to stick in people's heads, turning the quantum into the classical.

The big difference between quantum physics (and chemistry and engineering) and quantum woo is that with a quantum physical system, you can make a detailed prediction of how your system will behave, and do detailed experiments that demonstrate that your system actually does behave that way (in some cases, to ten decimal places or more). Quantum woo can’t do this, because if the experiment can be performed at all, it can only be performed once (on you, the subject).

I dunno; are identically prepared states really essential if one is positing one or more (not countably infinite, i.e., personal) additional fields?

Tradition acupuncture was much different. Before the practice was modernized, needles of different metals were used. Each metal has its own reduction potential

I take it that by "reduction," you are referring of circulating blood volume.

No, just kidding.

and in this way, microcurrents could be induced.

How did this work, e.g., with bone "needles"?

^ "referring of to"

This guy says: "How did this work, e.g., with bone “needles”?"

It doesn't.

Why would you say such a thing?

This guy says: “How did this work, e.g., with bone “needles”?”

It doesn’t.

Why would you say such a thing?

Offhand, I'm guessing it's because I have more knowledge of the history of acupuncture than you do. Then again, the history is the only part of the farce that I find interesting.

#2 kissmetoad

Everything about your post is one of the primary reasons CAM exists. Why MUST there be something that can help you? Its an honest question and I want you to honestly consider your answer. Is it an impossibility that there just ISNT something that currently exists to help you with that particular issue you have?

This automatic assumption that things exist to help people (which actually might be true) AND that we know what they all are (this is definitively not true) leads to people being able to claim snake oil does X and Y without every having to prove it., because hey....something MUST work right, why not this?

I think if people actually accepted that there are many things that we simply do not have any remedies for, then we would see less of this snake oil.

@Palindrom--There was a same name person as E.L. that went to said school with imaginary rabbit first name and last name same as last name of Star Trek character who had lots of women (hence name of episode as "XXXX's Women"). Also if you don't say the name of this college with proper enunciation, some will think you went to Harvard Med.

Why would you think that two bone needles, or two of any single material, could create and electric potential?

@Adrian

Well, fair question I guess. Firstly, I absolutely accept that there isn’t always an answer to every problem, but I don’t say that to a friend who has terminal cancer because it seems uncaring and rather cruel. Maybe I’m naive, but I though doctors want to relieve suffering and when there is no pill or other treatment, something more than a shrug should be there to assist with acceptance if nothing else.

Furthermore, I didn’t say I agreed with those who turn to woo when faced with a diagnosis with no real solution, just that I could see why people who have real symptoms would go looking for someone who cares.

I think I mostly agree with you--that people should accept the limitations of medical knowledge, and I often feel that way when I hear that someone I know has cancer and is going to “fight it with everything possible and beat it”, even when told it is too late for anything but buying a bit of time. Again, while I might think that the person should accept his fate, I would not say that to the person unless we were very close and I knew such a conversation would be welcome. That isn’t to say I would recommend or quietly tolerate a woo-ish alternative, but after a gentle reprimand, I’d let it go. Someone in my family is in this situation and all the rest are praying mightily for him. I stay out of it.

My comment was directed at exploring why people look to CAM and how medical people can respond so that they don’t. Orac, et al, often say that some of CAM is just regular medical advice dressed up to sound alternative, and I agree. My point is that they need to get better at offering standard advice in a way that connects with people. For example, when I was much younger, I told a doc I wanted to lose some weight. He reached into a file drawer and handed me a page with a sample 2000 calorie diet and left the room. Gee, I wonder why I spend the next 20 years reading stupid fad diet books? Luckily, for a variety of serendipitous reasons, I became a skeptic along the way and actually did lose the weight under the supervision of an RD.

I hope this helps.

darwinslapdog: Please don't change 'noms without announcing who you are. I have a close to absolute ban on sock puppets. I let your comment through because of your long history commenting here, but please pick a 'nym and stick with it. Don't change them without making it clear who you are. Fair's fair. If I enforce this policy brutally on quacks and cranks, I can't let friends go without being accused of selective enforcement.

Kissmetoad

All fair points. I understand deeply the idea of telling cancer patients that there might not be much else to be done, but I am a firm believer in clinical trials and there is an abundance of those available that already have evidence of efficacy. How many patients are forgoing those because they have been told that eating 5000 carrots a day and hooping joints will cure them. There is a cost to that false hope. It can deny them actual benefit from treatments in trials (likely not cures though) and also can make them live their life in a way that it isnt coming to an end because they cant accept it, and may cause them huge regret when their chosen woo doesnt work and they could have at least bucket listed some things.

Cheers,

Adrian

Zhang Wei, please explain the electrical circuit.

Ah, duct tape. Is there nothing it can’t do?

It does a surprisingly poor job sealing ducts.

Why would you think that two bone needles, or two of any single material, could create and electric potential?

One wouldn't logically think that. Why, then, would people claim that acupuncture with bone needles would have a benefit if that benefit required electrical currents?

Why, then, would people claim that acupuncture with bone needles would have a benefit if that benefit required electrical currents?

Well, you have to wiggle them for triboelectric generation.

I think it is mostly about window dressing and cash flow.

If it attracts fickle patients seeking extra mental or physical comforts, so be it, is the message.

In my area of the cancer universe, normal US billings are $40,000 to $60,000 per month. CTCA can add several minor features or items and some minor supplements for over $100,000 per month. From a bonus based management pov, what's not to like?

Also, it probably helps diffuse blame and regrets when the treatments, conventional and not, fail. ( the patient progresses or dies)

Notes:
I have never been a patient of CTCA but knew someone.
The supplement schedules for CTCA that I've seen were not nearly as potent as I think is required to produced physiological responese.
Supplements can be cheap.

Does anyone know whether Dr. David Spiegel still believes in the reality of multiple personality disorder (Dissociative Identity Disorder)?

It does a surprisingly poor job sealing ducts.

Hence the root etymology.

^ Jan Freeman notwithstanding.

Does anyone know whether Dr. David Spiegel still believes in the reality of multiple personality disorder (Dissociative Identity Disorder)?

He certainly appears to be actively promoting that field of fraudulent malpractice.

Quackery expands in the Dana Farber Cancer Institute and Children's Hospital of Philadelphia

oracknows — Tue, 28 Jun 2016 01:11:01 +0000

Quackery expands in the Dana Farber Cancer Institute and Children's Hospital of Philadelphia

I’ve been writing about this topic so long—ever since the very beginning of this blog—that it seems as though I’ve always been doing it even though this blog has been in existence only 11 years and I didn’t really come to appreciate the problem until after I had started this blog. No, I’m not referring to the antivaccine movement, which is another longstanding concern of mine. This time, I’m referring to what I like to refer to as “quackademic medicine,” defined as the infiltration of unscientific and pseudoscientific medicine into medical academia. Indeed, there was a time when I tried to keep track of all the once proud bastions of medical science that had descended into “integrating” the rankest quackery with their real medicine. At the time, I referred to my list as my “Academic Woo Aggregator.” Unfortunately, the number of academic institutions became too large and the variety of quackery too unwieldy for me to keep up with. The Academic Woo Aggregator rapidly fell hopelessly out of date. I gave up.

Still, I haven’t given up so much that I don’t take notice when major new members forsake science and adopt quackery, and unfortunately that’s exactly what’s happened at the Dana Farber Cancer Institute and Children’s Hospital of Philadelphia (CHOP). (Yes, CHOP is the home institution of Paul Offit, and I suspect he didn’t take this lying down.) I learned of the shame of two institutions through two articles, one about Dana Farber (Easing a patient’s pain — even without proof it works) and one about CHOP (After rejecting alternative medicine, CHOP gives acupuncture a shot). Even the titles are annoying.

Let’s start with CHOP, because CHOP teaches a lesson. “Integrative medicine” is relentless. In a way, it’s like naturopaths seeking licensure. Every time their lobbying efforts fail, they come back again. And again. And again. They do not give up until they get what they want. So it is with quackademic medicine. CHOP was hostile to unscientific medicine:

In the past, alternative options were not welcome at Children's Hospital. The institution removed most dietary supplements from its list of approved medications in 2013 because it could not guarantee their safety and effectiveness.

Paul Offit, chief of infectious diseases, said the hospital's stance on supplements would remain unchanged.

Unfortunately:

Children's Hospital of Philadelphia will offer acupuncture to all of its patients beginning in July, joining a growing number of pediatric medical centers providing alternative therapies.

The hospital plans to add other unconventional options, including therapeutic massage and aromatherapy, in the next year, said Maria R. Mascarenhas, medical director of the new Integrative Health Program.

"Our patients and families have been asking for it and seeking these therapies outside of CHOP," said Mascarenhas. "It's important for us to offer those services by providers who are up to CHOP's standards."

This is the same excuse quackademic programs always use, that they’ll somehow elevate the quackery, use it in an “evidence-based” manner, bring science to bear on it. The other claim is that they offer it because patients want it. My response to that is that patients often want a lot of things, but we’re under no obligation to give it to them if it’s unproven and not science-based. Unfortunately, the leaders of academic medicine don’t seem to see it that way any more. They’ll offer anything now: Acupuncture, traditional Chinese medicine, supplements, and worse. This program at CHOP is very modest at the moment. However, once pseudoscience gains a foothold in a medical institution, once an academic medical center gives itself over to quackademic medicine in the form of “complementary and alternative medicine” (CAM) or, the preferred term now, “integrative medicine,” it never goes back. Integrative medicine is like the Dark Side of the Force that way.

Meanwhile, Dr. Mascarenhas spews the same old nonsense about acupuncture as she justifies using it on children:

There is evidence that acupuncture works - specifically for pain. A 2012 analysis of dozens of randomized controlled trials concluded it effectively relieves some types of chronic pain.

"We don't fully understand how it works," said Mascarenhas, "but it's therapy that lets the body naturally reduce pain and improve functioning."

Children will have to be old enough to understand what the acupuncturist is doing.

"You need a cooperative patient," Mascarenhas said. "You don't want them moving during the therapy session."

Dr. Mascarenhas is, without a doubt, referring to the 2012 meta-analysis by Andrew Vickers, which did not actually show that acupuncture has any clinically meaningful effect on chronic pain. None of this stops her from parroting the same old meaningless tropes about how acupuncture is “natural” and just works.

One wonders if she’s even considered the ethics of using acupuncture on children. The ethics of offering unproven treatments—and most integrative medicine practitioners will admit that a lot of their treatments are unproven—to adults outside of the context of a clinical trial. However, administering unproven treatments to children is definitely problematic from an ethical standpoint, if not downright unethical. None of this seems to stop “integrative medicine” practitioners like Dr. Mascarenhas from forging boldly forward integrating quackery with real medicine without concern for such niceties. It’s also depressing that this could happen at the institution where Dr. Offit is faculty. I’d be shocked if he didn’t fight this tooth and nail; indeed, you can tell from his quotes in this story that he’s probably holding back because it’s never a good idea to outright badmouth your employer in a news story.

If acupuncture and a little woo are where CHOP is now, take a look at Dana Farber to see where CHOP could be in a few years:

Massage therapist Maria Barbara “Bambi’’ Mathay roamed the pediatric clinic at Dana-Farber Cancer Institute, looking for takers. It wasn’t long before she spotted Carlie Gonzalez, 15, wrapped in a yellow blanket and weary from seven months of chemotherapy.

Carlie was playing freshman volleyball at Milford High School last fall when an ache in her collarbone became intolerable. A CT scan revealed an aggressive bone cancer that required surgery and potent anticancer drugs that make Carlie nauseated.

As the liquid dripped into her arm, Carlie rolled up a pant leg for a session of foot reflexology. “It kind of takes your mind off your stomach,’’ she said. While Mathay gently pressed on her toes, Carlie sleepily closed her eyes.

Dana-Farber is embarking on its largest expansion yet of unconventional therapies. Over the past year, it has taken the unusual step of offering reiki, an ancient Asian technique, and foot reflexology free of charge to adults and children — as well as acupuncture to adults — in its outpatient infusion clinics during chemotherapy treatments.

I hate this “bait and switch.” Notice how it’s a massage therapist mentioned first. As I’ve said before many times, I don’t mind massage being offered to patients because in general it just feels good and is highly unlikely to cause harm. What I don’t like is how it’s gone from being “massage” to “massage therapy,” with claims of efficacy for various conditions that are often not well supported by science. What’s even worse, though, is how reflexology is represented as being just massage therapy. Yes, reflexology is a foot and hand massage, but the idea behind it is pure pseudoscientific quackery. Basically, in reflexology, the idea is that various organs map to various areas on the soles of the feet and palms of the hands. Through these “pathways,” reflexologists claim to be able to diagnose and treat disease through feeling the hands and feet. It’s pure rubbish.

And it’s being offered at the Dana Farber Cancer Institute, one of the most respected cancer centers in the US, if not the world. Quackademic medicine reigns supreme.

It’s worse than that, though:

The hospital soon will start a nearly $2 million project to convert the first floor of one of its buildings into a new center for “integrative therapies,’’ which eventually could double the number of patients it can accommodate. More than 3,000 patients scheduled appointments for acupuncture and massage last year, a 25 percent jump over 2014.

A growing body of research supports acupuncture as a treatment for pain and nausea in oncology patients, but few high-quality studies exist on the effectiveness of reflexology and reiki.

The investment by Dana-Farber, a leading cancer treatment center, underscores a growing willingness among mainstream medical institutions nationally to offer complementary therapies that appear to help patients — even without definitive proof.

Yes, Dana Farber is wasting $2 million to offer fairy dust to its patients. Reflexology relies on “pathways” between organs and the soles of the feet and palms of the hands that don’t exist, but reiki takes that one step beyond. (Apologies to Madness.) Basically, reiki masters claim the existence of a “universal source” of energy that they can channel through themselves into patients for healing effect. I know I make this analogy fairly frequently, but I don’t think it can be emphasized enough. Consider what we would call reiki if you substitute the word “God” for “universal source”—which you might as well do because what else do you call a blob of energy with a life of its own? You’d call it faith healing. Just as faith healers claim to be able to channel the healing power of God through themselves and into patients, reiki practitioners claim to be able to channel the healing power from the universal source into patients. The only difference, conceptually, between reiki and faith healing is that the former invokes Eastern mystical religious beliefs and the latter invokes Judeo-Christian religious beliefs. Reiki goes faith healing one step beyond, though. (Apologies to Madness again.) It provides healing over a distance and even healing backward and forward in time. It’s not “ancient,” either. Reiki was invented in the 1920s in Japan.

Unfortunately, reiki is everywhere in hospitals.

I like how the article describes reiki and other “energy therapies” as “controversial”:

The technique is controversial, however. MD Anderson Cancer Center in Houston decided against providing reiki or other so-called “energy therapies’’ because of lack of convincing evidence. In one small study published five years ago in the journal Cancer, researchers found little overall difference in depression and anxiety levels for men with prostate cancer who underwent either reiki, “relaxation response therapy,’’ or were put on a wait list — though reiki seemed to have some benefit for men who were anxious to begin with.

“We can’t say it’s any more than placebo at this stage,’’ said Lorenzo Cohen, director of integrative medicine at MD Anderson. “Patients report feeling better after a session of reiki. Would they feel better just sitting and speaking with an empathic person? They probably would.’’

Ligibel said more research is needed to sort this out. “I struggle with the mechanism of a lot of these therapies, but I’ve seen them work for people,’’ she said.

Dr. Jennifer Ligibel, by the way, is the director of the Leonard P. Zakim Center for Integrative Therapies and a breast oncologist, in other words, one of my people who turned to the Dark Side. Seriously, though. Even M.D. Anderson has stopped offering reiki because it’s too ridiculous. I learned this after I published an article on integrative oncology that mentioned M.D. Anderson as having a reiki program, which it actually did. However, my information was old. So I got an indignant letter pointing out how M.D. Anderson doesn’t offer reiki any more, to which my response was basically, “Great. Glad to hear it. But what about all that other pseudoscientific ‘integrative’ medicine you offer?”

As for Cohen’s remark about how patients would probably feel better just sitting and speaking with an empathetic person, I can’t help but suggest to Dr. Ligibel that perhaps she should can the reiki and hire some counselors. Of course, that would cost money, and Dana-Farber is training volunteers to administer reiki. One wonders why its administration won’t pony up some green to hire some actual professionals.

I kid, I kid.

I do find it interesting that this article, too, mentions a study, this time describing it thusly:

There is broader agreement on the benefits of acupuncture, which involves inserting thin needles into the skin at strategic points on the body. Traditional Chinese medicine holds that it balances energy flow, while Western practitioners believe it stimulates nerves, perhaps releasing natural painkillers. Memorial Sloan-Kettering Cancer Center researchers reviewed results of clinical trials involving 17,922 patients and found, on average, that acupuncture reduced chronic pain by more than 50 percent. That compared to 42 percent for “sham acupuncture’’ and 30 percent for no acupuncture.

Yep, it’s the Vickers meta-analysis again. And I say again, the Vickers meta-analysis is not good evidence supporting the efficacy of acupuncture. It is rather interesting how this is the go-to article quackademics always seem to refer to to argue that acupuncture works. It just goes to show how thin the evidence for acupuncture is.

Stories like this always depress the hell out of me. Here are two bastions of science-based medicine; yet there are faculty who work there who are so eagerly throw away science in order to embrace magic, mysticism, and faith healing in order to exchange the scientific for the pre-scientific or pseudoscientific. Unfortunately, they are a microcosm of what is happening all over medical academia, from medical schools to academic medical centers. Quackademia marches on, relentlessly apparently. I fear that if I were to try to recreate the Academic Woo Aggregator in 2016 it would be a book—and not a thin one.

oracknows Mon, 06/27/2016 - 21:11

Tags

Quackery

Children's Hospital of Philadelphia

Dana Farber Cancer Institute

http://www.ncbi.nlm.nih.gov/pubmed/9521847

Categories

Medicine

Quackademia is just the tip of the iceberg. Academic success is a question of power and money. What we need is scholarly societies independent of the current competition model, because competition has nothing to do with science.

Hey, a "reflexology" massage of my hands and feet would probably make me relaxed and sleepy,too. I have no belief that it would do anything for my organs or my health, but hey, I am always up for a good massage. On the other hand, one of my friends hates to have her feet touched. So "reflexology" wouldn't make her feel better at all.

It's very sad to see hospitals go over to quack medicine. I'm glad that CHOP is at least keeping its stand (for now!) agains supplements. But I'm sure, in these days of financial issues, hospitals are looking for ways to make money from their suckers patients that insurance won't cover.

My hospital is starting to go this way too, at least small potatoes, and beginning with exercise, yoga, meditation, and nutrition, so essentially just moving our PT, nutritionists, and pastoral care under one new umbrella name of "integrative care," which is infuriating.

Someone mentioned acupuncture, and my only hope is that as Infection Control, we can put a stop to that. I can see several ways we can work it, the simplest being the "practitioners" will have to comply with our flu plan (and NY's), but this isn't something we should have to do. Stroke-inducing rage.

I could sort of tolerate it if I knew the only reason is money and could believe that it will stay this way. Sure, it'd still be morally disgusting but in a way that conforms to reason. However it seems that using those modalities, even as a con at first, leads to a slippery slope of believing in them...

A more cynical person has to wonder if acupuncture is offered because of changing attitudes towards narcotic pain management, and a hope that the patient will be susceptible to the placebo effect.

It's all so depressing. The hospitals seem to re-discover that a few moments of quiet, low-stakes human interaction do wonders for the patient's mood and outlook. But instead of hiring more staff and training them in the art of the supportive chat, they spend money on mysticism. I'd be livid too.

I wonder if the rise of this pseudo-scientific BS is due to the internet making it more obvious and easier to find, or if the lack of a serious epidemic is causing people to forget what medicine has done for civilization. Either way I sorta approve of the Hollywood old west method of dealing with snake-oil peddlers (See the Outlaw Jose Wales for a fine fictitious example).

If I really want to depress myself, I consider that the administrators who are approving this know it's BS medically, but a great revenue stream with minimal expense. After all, how much does distilled water or a volunteer cost compared to what they can charge.

When I first heard the term "Integrative care" I thought they meant integrating care of emotional aspects of illness into care. For instance, I use meditation as part of my management of my OCD and anxiety. I wouldn't call it medical care, but it certainly is theraputic for me. And, after all, massage feels good and is relazing and I can see how aromatherpy could help with nausea or help eliminate the stress induced by "hospital smell."

When I found what what they really meant by "Integrative care" I was disappointed. Alt. fans compain about how "traditional" medicine is overly focused on illness, and noth the "whole" person, yet their insistance that they do all these impossible things, rather than just admiting "We can make you more comfortable and less anxious" tells me they are just as fixated on the idea of illness as they claim they are not.

@ Daniel

warning - derailing tangent

What we need is scholarly societies independent of the current competition model, because competition has nothing to do with science.

In a ideal world, maybe (well, maybe yes).
But in a world with (more and more) limited resources for scientific endeavors, how do you select the happy fews who get these resources to keep working on their chosen projects?
It's not like we are lacking of people with things to explore and study. There is going to be competition, no matter how you cut it.

@ Helianthus
There is a confusion between selecting good individuals and organizing a science competition. It would be very easy to raise the requirements for being a scientist, as many of them are ignorant even in their field, and a PhD does not mean much. Science competition forces scientists to work in domains chosen by politicians, and it is an obvious consequence that woo medicine will be favored, as well as the machine that goes ping . In addition, productivism is the other consequence of this competition, and then again it has nothing to do with science, as it is easier to produce papers than to answer relevant questions.

I’d be okay with all this as long as these centers are located in a room next to, and the same size as, the Chapel. This would remind people that they are dealing with a matter of faith.

And---what’s up with medical schools producing people who say things like, “I’ve seen it work”? What a waste of an education.

Dana Farber recently posted a propaganda video for their integrative medicine center.

@ Daniel

There is a confusion between selecting good individuals and organizing a science competition. It would be very easy to raise the requirements for being a scientist

I see your point, but that's not what I was talking about.
To put it simply, i was not talking about which student get a PhD, but about which lab director get the resources to train a PhD, hire a lab tech, buy a PCR or whatever else he wants to do.

Science competition forces scientists to work in domains chosen by politicians

Yes, I got this part. And I fully agree a system based on entregent rather than scientific facts is going to favor the more charismatic/vocal advocates, and favor alt-med.

But my point was, how do you get these domains chosen, if not by competition, when resources are limited?
You can set your own lab, but unless you are a fermier général à la Lavoisier and hence filthy rich, you are still depending on the outside world to provide you the means to your research. That put you on direct competition with all the others, and again the one using the more buzzwords/pretending to be the more productive win.

(note that I am not saying it's impossible to improve/reform the current system; I'm just wondering what solutions you have in mind to reduce competition/politics)

I’d be okay with all this as long as these centers are located in a room next to, and the same size as, the Chapel. This would remind people that they are dealing with a matter of faith.

I've often said that I wouldn't mind reiki practitioners being allowed in hospitals if they were treated the same way as chaplains—just there for spiritual support with no claim that what they are doing is in any way legitimate medicine, and imprimatur of the hospital placed on them. Unfortunately, that's not what's happening.

warning – derailing tangent

Then just say no. Daniel is unfortunately all too proficient at derailing comment threads.

@ Orac

OK, and my apologies.
Curiosity got the better of me.

As always you keep us aware of what is going on out there. This can be frustrating.
I was trained as an oncology massage therapist. We learned Swedish massage and lymphatic drainage, as well as reflexology, aromatherapy and reiki. (The reiki always left me sort of Meh.) Funny thing is, not once were we taught that we could cure cancer. We learned about illnesses, contraindications and got to clinic at a major hospital. What did massage actually do? It relaxed the patients, some even napped while getting chemo and others said their stomach settled down and they could finally eat. Some patients liked to chat during their sessions, others not at all. I met lovely people battling horrible diseases, recovering from car accidents, drug addiction, while others were close to dying and in hospice. The nurses appreciated our presence and we were very welcome in the ICU, CCU and infusion room.
I do not like to see massage grouped in with other therapies as quackery. It isn't. Unfortunately some of the people who practice it wield it like some magic cure all which does not help its cause. No one should sell massage as a way of beating or removing an illness. They should pitch it as gentle touch for a body that has been poked and prodded to no end. You cannot do a vigorous spa massage on these patients. We learned how to read charts and be very aware if all we could do was rub a hand or feet. I hope to God these "integrative centers" are screening therapists wisely or there can be serious complications.

I’ve often said that I wouldn’t mind reiki practitioners being allowed in hospitals if they were treated the same way as chaplains—just there for spiritual support with no claim that what they are doing is in any way legitimate medicine

The key difference is that chaplains are actually trained to provide such support, and therefore provide a useful if non-medical service to patients. I have seen no evidence that reiki practitioners are similarly trained.

The chaplains also understand, for the most part, that they're not there to proselytize. I fear that a reiki practitioner is all too likely to do so.

The underlying reason for the spread of woo in the US is that even academic medical centers consider themselves profit-oriented businesses. They have to compete for patients, so if the patients are superstitious, the medical businesses will offer them superstition-based treatments, no matter how (in)effective, and hope to get bigger market share and reimbursement for legitimate procedures on the same patient.--
It is a cynical exploitation of people's ignorance, just when they are most vulnerable.
(Slightly off-topic: Another example I recently witnessed was from a family where the mother, in her 40ies, had terminal stomach cancer. After diagnosis, in addition to regular chemo, the family spent some $1000 on some 'Fuocidan,' a miracle supplement which was supposed to have helped someone somewhere. Of course, sadly, it didn't, the patient died. But it seemed heartless to tell the family that they had a false hope and very victims of a scam. Hope that anybody googling Fuocidan will see SCAM come up with it, rather than ads for it.)

The hospital soon will start a nearly $2 million project to convert the first floor of one of its buildings into a new center for “integrative therapies,’’ which eventually could double the number of patients it can accommodate.

But not double the number of patients it will treat.

@ Helianthus
"you are still depending on the outside world to provide you the means to your research."
I agree with you, but the means have become the ends. For most research, we would not need so much money if journals were not asking for more and more technics. Did Einstein need money for his papers? Or Watson and Crick? All these works would be rated by academic institutions as "Review Articles" and not as important as Big Data.
It's economics that drives most of the scientific activity, and the economy of research has drastically changed in the last decades. It does not surprise me that the changes benefit to quackademia.

@Eric Lund: The chaplains also understand, for the most part, that they’re not there to proselytize. I fear that a reiki practitioner is all too likely to do so.

My most recent hospitalization, the chaplain dropped by. Asked if I needed anything. I said no, I'm an atheist, and he smiled and said OK, is there anything I can get you? I answered no, we exchanged a few more pleasantries, and he left. I imagine that a reiki believer would be much harder to get rid of.

"You just had surgery! Let me wave my hands over you and smooth out your aura!"

No, thanks, I don't believe in it.

"Oh, that's OK. You don't have to believe. - commences hand waving"

Please leave me alone.

"Don't you feel the warmth?"

No. Go away.

Note: I had a massage therapist claim he was doing reiki at the end of a session. He kept asking me if I felt the warmth of his hands - 5 inches above my back. He was extremely upset that I kept answering no, I didn't feel anything. Last time I went to him (it was also the first.)

Fucoidan might promote tumor cell metastasis, as indicated by this study.

He kept asking me if I felt the warmth of his hands – 5 inches above my back. He was extremely upset that I kept answering no, I didn’t feel anything.

So his Jedi mind trick didn't work. Good.

Incidentally, in physics "handwaving" refers to a different form of Jedi mind trick, namely the common practice, whether in the classroom or in a research paper/presentation, of asserting something without going through a mathematically rigorous definition. But at least in physics the thing being asserted is plausible, and more often than not turns out to be true if you actually do the derivation. The assertions of reiki practitioners that their handwaving is beneficial to the patient are not even remotely plausible. Reiki is just a fancied-up version of theraputic touch, which was thoroughly debunked in then nine-year-old Emily Rosa's science fair project.

As a participant in a recent** experiment, I can attest that acupuncture doesn't help as much as gin or wine.

** self managed N=1

In other news...

it seems that Mikey's contributions** to the victims of Dr Fata group were not appreciated at all-
so he'll send them to an Indian/ Native American reservation since he TOO is now claiming native heritage.
( -btw- he looks like a regular old whitey to me. I think that Null also claims this )

** of supplements, what else?

When I was being introduced to my nurse the last time I was in the hospital, Mr. STFU (we have different last names) cribbed the plot from a story and asked if the nurse did any of that therapeutic touch. She beamed and said yes, I've been trained. Mr. STFU said, well, don't do any of that on my wife, if she wakes up and sees you waving your hands over her, she might think you're a ghost and get frightened. The nurse pouted.
In the story, (supposedly true) the elderly patient was so frightened when he woke up, he tried to get out of bed but fell and injured himself. He then insisted on being discharged, but had to be readmitted to a different hospital later in the week. His son was very unhappy about the whole thing.

FYI Perhaps things have changed, but when I received reiki treatments it wasn't hand waving. I was lying on a bed, and the 3-4 practitioners would slide their hands just under you, as if they were going to lift and transfer you, and then stand there silently and “channel the loving, healing energy.” Therapeutic touch was the non-touch handwaving. Not that the distinction between the two makes any difference whatsoever. [in my defense, the reiki was free, I didn't know what it was exactly, thought what the heck, and concluded it was really stupid]
What gripes me, is even if that nurse only spent five minutes practicing therapeutic touch, that was five minutes that another patient was not getting real nursing care.
RE aromatherapy, and creating an feeling of pleasantness associated with hospital care, isn't it just as likely to create a dislike of whatever scent their using and then ruin a good day when the scent later makes the patient think about illness or surgery? A friend of mine spent so much time in doctor's office waiting rooms with soothing aquariums, that she avoids Chinese restaurants that have goldfish tanks because they trigger emotions about her husband's cancer death.

edit; whatever scent they are...

This infuriates me. My 6 year old daughter has a very treatable form of cancer (thank god), but the treatment has included major surgery, chemo, radiation, a broviac, etc... She handles it all pretty well, but we explain that is it necessary. I've had acupuncture as an adult (before I knew better) and it's kinda scary. Kids are afraid enough of needles as it is, subjecting them to a therapy that doesn't work is absolutely unethical, especially when they are poked and prodded enough. Want to give them a foot massage? Fine, just don't call it reflexology. But acupuncture? Are they out of their minds? Kids don't know better. If an adult tells them it works, they believe them. It's just mean.

mho (#27):
That's an interesting point about the aquariums. The clinic where I go, at the moment fortunately just to see the oncologist for check-ups, has a fair size aquarium in the patient waiting area (and they show nature-ish videos, like beaches and water, on a big-screen TV). But Chinese restaurants don't seem to have them as much any more. For me, smell rather than sight or sound is a more potent emotional trigger - and I think that's the case for most people, because of the very "hard-wired" connection between the brain and the olfactory bulb. Proust and madeleines.

it seems that Mikey’s contributions** to the victims of Dr Fata group were not appreciated at all

This has to be seen to be believed, as it were. It is hilariously devoid of documentation, and ends with this:

"ACTION ITEM: Shame the idiotic leaders of the Dr. Farid Fata victims group [sic]"

Gee, Mike, maybe they could smell you from a mile away. (The FB group is closed.) L-rd knows that your response when you're spurned is a pretty serious tell.

The even dumber part is that he doesn't seem to understand the timing (Fata was shut down nearly three years ago) or what the group is for (hint: Geraldine Parkin wasn't a patient).

Acupuncture on children sounds like "as long as you say or show that you are in pain we will stick you with needles," so some kids will be conditioned to hide their pain so they don't get stuck with more needles.

(Yes, I have heard that acupuncture needles don't hurt, but you can still see them sticking out of you. And they must hurt on some level.)

^ Second link should've closed after "FB group," but it works.

@mho:

Scent is supposed to be great for triggering memories. Perhaps aromatherapy would work best if they used "grandma's homemade cookies" instead of lavender, chamomile, lemon, etc...

The stuff about reflexology and massage therapy kind of tempts me to go get 'certified' and see just how ridiculous I could be before somebody objects to the nonsense. Like, could I get to "Baba the Cosmic Barber" levels? https://www.youtube.com/watch?v=geLtFCxDs40

Mrs Woo, I can tell you that on this day, when I'm having both pain and breathing problems, the smell of my Grandma's molasses cookies would make me feel better - or at least take my mind off my back, hip, and lungs. Maybe someone should go into the Cookie Aroma Therapy Business? I do kid. Honestly.

(note: please shield your irony meters)

The outrage with which a certain woo-ster is reacting to his refused donation of vitamin C supplements is especially amusing, considering that his website has previously denounced the practice of drug companies handing out free samples. Their article quoted a PLOS One study:

""It is difficult to escape the conclusion," Dr. Chimonas and Dr. Kassirer wrote, "that the prime motivation behind the provision of free samples is marketing."

One might cynically speculate that the exact same motive is behind a supplement marketer "donating" his product (which is much costlier than what's readily available from other vitamin suppliers).

he TOO is now claiming native heritage.
( -btw- he looks like a regular old whitey to me. I think that Null also claims this )

Some tribes consider 1/32 ancestry sufficient for membership. The Cherokee are among them, as has been in the news recently regarding Sen. Warren (who does not claim membership in the tribe but would qualify if she did). Others require at least 50% ancestry.

Most people with 1/32 ancestry from any minority group would probably be taken for white. Many could pass with as much as 1/8 ancestry. I know a professor who is originally from New Zealand and looks completely white, but one of his great-grandfathers was Chinese. The only clue is his surname--it happens to have been his father's father's father.

test

Children will have to be old enough to understand what the acupuncturist is doing.

To me that sounds like an admission that it "works" through theatrical placebo, no? Sticking needles into someone will only "work" if the patient thinks it will - a young child would not have any idea why you're sticking them with needles.

Children will have to be old enough to understand what the acupuncturist is doing.

@Amethyst #40
My assumption when reading that was that the kids should be old enough to know that the procedure would be part of their "treatment" and what it entailed, so as not to trigger panic/anxiety (rather than the idea they'd be old enough to understand how the acupuncture was supposed to work).

Seems to me that requiring the children be old enough to "understand," is a good CYA, because the normal reaction of tiny children having needles stuck into them is to squirm, wiggle, and try to get away. Therefore, the requirement would avoid injury and accompanying lawsuits, IMO.

@ JustaTech:

They actually don't hurt but at least one ( in my very limited experience) caused quite a blood stain on the practitioner's clean white paper cot cover ( I tend to bleed like mad ).

HOWEVER the prelude to the needles involves much concerted poking and prodding of sensitive 'points' with bony fingers and a true belief in the existence of meridians and said points.

@ Eric Lund:

I know I know but I can't resist the urge to insult Mikey.
And he does look like a fine example of whitey-ness.

AND I nearly forgot how absolutely atrocious the cupping nonsense was- which left octopus-dalliance type bruises.

@ Ellie:

Don't laugh but I think that they do sell a cookie / cupcake scent these days.

@ Denice Walter - I understand. I have "creme brulee" candles, but I don't look at them as any kind of therapy. I don't pay enough for them for that - but the thought does make me smile.

@ Brook - Very interesting.

@Ellie - check out Alice and the Magician. He makes a chocolate cake mist that's amazing.

The simplest answer to underperforming hospitals ?
Patients should pull the plug and vote with their feet.

We can do many things better or more cost effectively at home or at a clinic. So hospitals are a bid situation or a last resort instead of the automatic std option. We use hospitals very selectively, mostly for scans and hard to get labs, without overnights.

So we have largely gotten rid of the hospital and kept the supplements.

prn: "Patients should pull the plug and vote with their feet. "

Even with a procedure that is done in only two hospitals in the entire USA?

"So we have largely gotten rid of the hospital and kept the supplements."

Oh, do please tell me what supplement would remove the extra heart muscle almost blocking the aortic valve due to obstructive hypertrophic cardiomyopathy.

Do you ever think before typing? One of the medical centers under discussion is the Dana Farber Cancer Institute. Do you really think some supplement is going remove a cancerous tumor or cure leukemia? Wait, did you even read the article? Where was the "underperforming" even mentioned?

Since I started reading this blog I have come to understand what a travesty it is that where I work is offering alternative medicine. The founder of where I work was the first real doctor in the area because of his skill when the new hospital opened they put him in charge. He got so sick of his patients dying there because of a quack doctors (it was actually a scalpel through the eye incident that sent him over the edge) that he pursued legal means to bar the quack doctors from practicing at his hospital. He fought hundreds of court cases with quacks, and won every single one. When I first started they used to have a big book with all the original court documents in it sitting in the main lobby. Since they started offering alternative that book has been removed.

prn: “Patients should pull the plug and vote with their feet.
chris: Even with a procedure that is done in only two hospitals in the entire USA?
Clearly voting with ones feet on the other 99.9+% (H-2) of US hospitals is the way to go, right? We are more fortunate in that home based chemo and supplements have been cheaper, safer and more effective than any hospitals.
----------
Oh, do please tell me what supplement would...
Of course I don't have a solution for you. Sorry. However, I would wonder what (nutrtional) chemical or biological treatments could have aborted the underlying processes of its formation, and would still investigate while working on other pathways.

One of the thrills of being alive today is how many times there are such answers for supposedly irreversible problems.
---------
One of the medical centers under discussion is the Dana Farber Cancer Institute.
A center is an agglomeration of many varied skills and equipment. One skill does not mean skill in another. It is common that unavailable modalities are downplayed or bad mouthed. I mentioned this several years ago to you, when I cited this on proton therapy.
----------
Do you really think some supplement is going remove a cancerous tumor or cure leukemia?
Yes, I certainly do think some combinations of cheap off label drugs and specific supplements help kill intractable cancers. Furthermore, some of our consulting MSM PhD and MDs do too. Some here might be behind on the state of the art, or even the predecessors. By decades.

As one example, there are very interesting papers on menaquinone-4, the primary human version of vitamin K2, for several cancers including leukemias. Most the papers available concern early monotherapy experiments and trials. The art is at multiple items in a cocktail.
--------
Chris:Wait, did you even read the article? Where was the “underperforming” even mentioned?

Orac/CHOPS: ...[CHOPS] removed most dietary supplements from its list of approved medications in 2013 ...
That's a clear sign of systemic bias and underperformance to me.... :>

Oh joy. prn has found his way over from SBM to bloviate about better living through supplements. He does, of course, just happen to sell JUST the right supplement to cure whatever ails you.

prn: The place is CHOP. Not CHOPS. CHOP stands for Children's Hospital of Philadelphia. And good for them that they've managed to keep untested and uncontrolled supplements out, even though they have bent to increased income by fake treatments and quackery.

@ prn

However, I would wonder what (nutrtional) chemical or biological treatments could have aborted the underlying processes

prn, when talking about using chemicals to treat health issues starting in the fetus, you may want to avoid using words like "aborted".
Just saying.

prn: "However, I would wonder what (nutrtional) chemical or biological treatments could have aborted the underlying processes of its formation, and would still investigate while working on other pathways."

Really? Obstructive hypertrophic cardiomyopathy is a genetic heart anomaly. Do you understand what the word "genetic" means? Do you even know how to use a search engine to get a definition of "obstructive" and "hypertrophic cardiomyopathy"

"Yes, I certainly do think some combinations of cheap off label drugs and specific supplements help kill intractable cancers"

Citation needed. Something more that what you "think."

prn, I am so glad that you "So we have largely gotten rid of the hospital and kept the supplements."

Now, how does that work for someone who just got hit by a truck and needs extensive orthopedic surgery? Or for the woman who needs an emergency c-section? Or the baby with meningitis who needs a breathing tube?

It's nice that you don't need hospitals. But for the rest of us, when life goes completely pear shaped, we'd like to have hospitals available.

Because no supplement in the universe is going to be able to negate the basic laws of physics, like F=ma.

prn, why are you here? You and your "consulting MSM PhD and MDs" have some kind of cure for diabetes:

If you were diabetic or borderline before, and now you are running HgbA1C 4.5 – 5 without medication, maybe you’re doing something right.

You and your "consulting MSM PhD and MDs" have cures for numerous forms of cancer ("I certainly do think some combinations of cheap off label drugs and specific supplements help kill intractable cancers", #52 above). Why are you here? Why aren’t you out helping your "consulting MSM PhD and MDs" to set up clinical trials of all these fabulous cures?

Before you say, “oh, woe, no Big Pharma funding”, I will remind you that, as I have described before, once upon a time I did data entry for an MD in private practice who believed he had a cure for a disease, set up his own clinical trial, and proved it.

I get really annoyed with CAM fans who whine that they have a cure but they can’t prove because of wicked Big Pharma. Do what he did. Set up a trial, do it right, and report the results honestly. If you really have a cure for anything that’s better than the standard of care, prove it!

And again a potential victim of mr. Burzinsky. This time a crowdfunding action in my country. Luckily there are some critical reactions, but of course also someone, who links to the movie that our respected host and others have torn apart.
http://www.omroepwest.nl/nieuws/3186048/Sabine-14-heeft-zeldzame-hersen…
Alas just in Dutch, but perhaps Google translate can help a bit.

The Dutch girl from my last post has an English site, which wasn't up a few days ago.
http://sabii.nu/en/

Should we follow the traditional Western treatment of chemotherapy my chance of survival is estimated at 2 to 5%. The treatment which I will be receiving at Dr. Burzynski's clinic will hopefully succeed in stopping the growth of the tumor.

So torn. I'm sitting here looking at the Contact-page. Far be it for me to tell this poor girl, her family and friends, that she will most likely die. To tell her the truth about about what a scamming huckster Burzynski truly is, and how his snakeoil has no track record of success.

But on the other hand, if nobody changes their minds, she will just become another of his victims...

Oh and Renate, could you have a look at this?

http://kanker-actueel.nl/NL/resultaten-van-burzynski-bij-hersentumoren-…

She links to it as "results of his treatments". Curious as to what it might be.

Well, I've looked at the site, but it's just someone who comes with a positive story about Burzynski's results. I suppose our host have torn it apart. It's translation of some English stuff. It has one critical reaction.
The people behind the website are very much into defending all kinds of quacks.

I've reacted on the article mentioned in my post on July 1 and placed some links to critical articles as well and some others have reacted as well. Of course there were also reactions of someone defending Burzynski and linking to the movie, that our host has torn apart as well.
Another person tells her to go to a Dutch quack, who offers Gerson therapy.

You can lead a horse to water but you can't make it drink. In this case, you can warn someone for the quacks, but it's no use if they don't want to listen. Writing her personally, through her site, is not really something I would want to do. Some of her sponsors are quacks as well.

Ask the Comptroller at CHOP how much money they were not capturing every time a family was seeking alt-therapies outside of CHOP.

Deep Throat admonition still hold true. Cleveland Clinic can tell you that (Mark Hyman anyone?)

There is just as much success as there is failures in Alternative OR Traditional Western Medicine!! This whole website is based on ignorance! I didnt know such a stupid website existed until I accidently stumbled upon it. I guess that should tell you something. Do some research for God's sake!!! Know what you are talking about before running your mouth and save yourself the embarrassment of looking like total idiots. There is alot more to Natural Medicine then what any of you who bash it obviously know! The quacks are the ones that suck you dry financially before they let you die a painful death (oh.. or a real comfortable one with more poison that helps the process along) from a disease that could be cured thru Natural Medicine!! This website is a joke and probably put up by the quacks in traditonal western medicine!!

@Emelia.
Since there is just as much success in alternative medicine as standard of care medicine, I'm sure you can provide 3 Pubmed citations for alternative therapies (no diet or exercise) discussed in this article that have been shown to be effective for non-self-limiting conditions.

NCCAM or whatever they renamed themselves have been doing lots of research for Congress's sake and haven't found any.

What is the best natural medicine therapy for ideopathic seizures? Or Type 1 diabetes? Or Parkinson's disease? Or how about an acute adenoidal renal cell carcinoma?

Please tell us more about Natural Medicine.

And can you list any doctors practicing standard of care treatments who encourage their patients to open GoFundMe sites to help pay to be experimented on?

The MEND™ protocol for Alzheimer’s disease: Functional medicine on steroids? (revisited)

oracknows — Fri, 24 Jun 2016 01:43:49 +0000

The MEND™ protocol for Alzheimer’s disease: Functional medicine on steroids? (revisited)

A week ago, I wrote about an example of one of the most common topics on this blog, the infiltration of pseudoscientific medicine and outright fantasy into academic medicine, a trend I like to refer to as quackademic medicine. The institution was George Washington University, and the dubious intervention was something called the MEND™ Protocol, which is sold as a treatment for Alzheimer’s disease by Muses Labs. As I described, it’s a protocol that appears to rely on a proprietary computer algorithm of some kind that, according to Muses Labs, produces a “personalized” treatment plan for Alzheimer's disease. As if the proprietary computer algorithm wasn’t a big enough red flag for you, the results of the algorithm, at least as far as I could tell, produced a list of “integrative medicine” interventions ranging from the unobjectionable (e.g., exercise, getting 8 hours of sleep a night, treating sleep apnea if present) to those lacking evidence (e.g., gluten-free or low glycemic diets) to the highly dubious (basically, a boatload of supplements). In support of the MEND™ Protocol, Muses Labs touted a study by Dale E. Bresden that didn’t read like a study at all. Basically, it was a case series, and it was close to impossible to figure exactly what was used in each patient.

Leave it to me to have such fantastic timing, though. The dubious study I mentioned above dates back to 2014; so it was due for updating. Guess what? On the very day I was writing that post for last week, there was a press release announcing the publication of a followup study, Pre and post testing show reversal of memory loss from Alzheimer's disease in 10 patients: Small trial succeeds using systems approach to memory disorders. Let’s just say this press release...exaggerates. (Imagine that!) For one thing, the MEND™ Protocol can hardly be called a “systems” approach. At least, if it can, we have no way of knowing because nowhere is the approach described in anything resembling sufficient detail to allow a careful evaluation of its “systems approach.”

Just like last time, Bredesen is laying down woo babble (like Star Trek technobabble, only with woo) like this:

Effective treatment of Alzheimer's disease has been lacking, but recently a novel programmatic approach involving metabolic enhancement was described, with promising anecdotal results [3]. This treatment is based on connectomic studies [4] and previous transgenic findings [5] as well as epidemiological studies of various monotherapeutic components of the overall program [6]. The approach is personalized, responsive to suboptimal metabolic parameters that reflect a network imbalance in synaptic establishment and maintenance vs. reorganization, and progressive in that continued optimization is sought through iterative treatment and metabolic characterization.

OK, maybe it’s not as impressive as last time, with its claim of “synaptic reconstruction” invoking mechanisms like “periodically activating autophagy, blocking prionic tau amplification, increasing beta-amyloid clearance, inhibiting beta-amyloid oligomerization, minimizing inflammation, normalizing neurotrophic factors, reducing ApoE Ɛ4- mediated signals, reducing stress, reducing tau phosphorylation, restoring cholinergic neuro- transmission, and reversing memory loss,” from which the protocol targets “specific biological mechanisms are then prioritized and prescribed to optimize key biological mechanisms.” Maybe Bredesen was told to tone it down.

As Steve Novella notes, basically, this protocol appears to look at every marker Muses Labs can find that has been implicated in Alzheimer’s disease without actually bothering to figure out if these markers are actually etiologically linked to Alzheimer’s disease (i.e., might cause it) or are just epiphenomena (i.e., are coincidental or linked to something else that’s linked to Alzheimer’s disease and not causative). I referred to the MEND™ protocol as functional medicine on steroids, because, whether the scientists at Muses Labs know it or not, that’s exactly what functional medicine does: Measure a lot of markers that basic science and/or epidemiological studies have tentatively linked to various diseases without regard to whether these markers have been shown to have a causative role in these diseases, and then try to fix their abnormal levels. In doing so, functional medicine ignores an adage I’ve been taught since I was a resident: Treat the patient, not the lab values.

In any case, given that the new publication by Bredesen et al, Reversal of cognitive decline in Alzheimer's disease, is a followup to the 2014 case series, I wondered if it would correct some of the glaring flaws in the previous study, such as its failure to provide any details that could allow a reader to evaluate whether the protocol has any value. Heck, there still isn’t enough detail to figure out on what basis sets of interventions were chosen for individual patients. Moreover, the study is uncontrolled. There is only one group, and all of the patients studied improved, at least subjectively.

This time, the only difference is that some seemingly “objective” data on each patient are included, such as tests of cognitive function and quantitative MRI. Of course, quantitative MRI is not straightforward to carry out and prone to many pitfalls and artifacts. Without a careful description of how MRI data were obtained for each patient, along with representative imaged, it’s impossible to tell if the investigators knew the potential pitfalls and took steps to minimize them. Given Bredesen’s history, I have to wonder.

Certainly, they appear not to have known the pitfalls of using FDG-PET scanning either. PET scans measure glucose utilization, and in part Bredesen relies on these scans showing glucose hypo-metabolism (decreased glucose uptake/utilization) to conclude that they have cognitive impairment. However, this has been found in subjects without cognitive impairment, particularly APOE-epsilon carriers, and 9/10 of the patients described are APOE-epsilon(+). Consequently, the significance of Bredesen’s FDG-PET findings regarding cognitive impairment are unclear.

More frustratingly, there was no indication how these patients were selected. Case series are usually supposed to be just that, a series of cases, usually consecutive. The reason for including consecutive cases is to minimize the tendency to cherry pick only the best cases and leave out cases with less favorable results. If the case series isn’t consecutive, then it’s very critical to know how the patients were selected for inclusion. In other words, you have to predefine rigorous selection criteria by which you will select your patients for inclusion in the case series. Barring that, it’s hard not to wonder if the patients were picked for best results, in which case what you have is a best case series. As we know from the example of Nicolas Gonzalez’s best case series of 12 patients with pancreatic cancer treated with his protocol, which involved many supplements and coffee enemas, best case series can be very misleading. Gonzalez’s series appeared to show results better than historical controls, but when his protocol was finally tested in a controlled clinical trial, the patients receiving his protocol actually did worse than controls, and that’s saying a lot, given how poorly patients with pancreatic cancer do in general. I strongly suspect that Bredesen’s patients are a best case series, but I can’t prove it. On the other hand, if it’s not a cherry picked series of cases, Breseden et al give no indication of it and every indication of their series not being consecutive.

Basically, this new case series is no better than the 2014 case series. It just sounds more science-y.

As Steve Novella notes:

The data, of course, is unblinded, meaning that it is very unreliable. In my experience as a neurologist, cognitive function can be very subjective. It is affected by mood, by transient things such as sleep, and there is also a huge element of subjective perception.

Some of the subjects did better on neuropsychological testing, but there is a known practice effect to such standardized tests. Patients always do better on the second taking.

They present 10 cases, but there is no mention of how these 10 cases were selected and if they are representative.

I also note that the authors refer to patients as having “Alzheimer’s disease” when in fact they should have referred to them as “Alzheimer’s type dementia.” AD is a pathological diagnosis, and there is no mention of brain biopsy on any of the cases. They met clinical criteria for Alzheimer’s type dementia, which is not the same as confirming AD.

Exactly. While a preliminary case series of ten subjects is not unreasonable as a pilot study, without a clear description of clear inclusion criteria, how each set of interventions was chosen for each patient, clear descriptions of the exact protocol followed, and predefined criteria for success, a case series like Bredesen’s is virtually worthless even to tell us if there’s anything worth following up on with a randomized controlled trial.

There are a number of other red flags in the study as well. For instance, in Table 1, one of the patients is referred to as having “Mild Cognitive Impairment (MCI), type 2 (and possibly type 3 (toxic)).” In a previous article (published in Aging, natch!), Bredesen defines “toxic” Alzheimer’s disease thusly:

Alzheimer's disease is one of the most significant healthcare problems today, with a dire need for effective treatment. Identifying subtypes of Alzheimer's disease may aid in the development of therapeutics, and recently three different subtypes have been described: type 1 (inflammatory), type 2 (non-inflammatory or atrophic), and type 3 (cortical). Here I report that type 3 Alzheimer's disease is the result of exposure to specific toxins, and is most commonly inhalational (IAD), a phenotypic manifestation of chronic inflammatory response syndrome (CIRS), due to biotoxins such as mycotoxins.

Upon what does he base this? What is CIRS? It turns out that Bredesen bases his hypothesis on the work of Dr. Ritchie Shoemaker:

Over the past two decades, elegant work from Dr. R. Shoemaker and his colleagues has demonstrated unequivocally that biotoxins such as mycotoxins are associated with a broad range of symptoms, including cognitive decline (summarized in [5]). These researchers and clinicians identified a constellation of symptoms, signs, genetic predisposition (HLA-DR/DQ haplotypes), and laboratory abnormalities characteristic of patients exposed to, and sensitive to, these biotoxins. The resulting syndrome has been designated chronic inflammatory response syndrome (CIRS).

Let’s just say that Dr. Shoemaker has been graced with his very own entries in Casewatch, including a copy of a warning letter from the FDA. Shoemaker’s website, SurvivingMold, is what I like to call a “target-rich environment” that I might have to look into in more detail one day. Basically, he’s into chronic Lyme disease (a nonexistent diagnosis) and blames many chronic conditions on mold.

There are other red flags. For instance, Bredesen didn’t disclose some relevant conflicts of interest (COIs). One such COI was that he was one of the founders of Muses Labs. He didn’t disclose this for his 2014 paper. Of course, he is no longer affiliated with Muses Labs, but that doesn’t mean he doesn’t still have a COI. For example, he is the founder of MPI Cognition, as shown in this recent press release. On the MPI Cognition website:

The Protocol provides a comprehensive personalized program designed to improve cognition and reverse the cognitive decline of SCI, MCI, and early Alzheimer’s disease. Continued research and testing by Dr. Bredesen began by evolving MEND into The Bredesen Protocol, which has identified new and previously unrecognized causes of Alzheimer’s disease.

How did he do it? Prepare for new woo babble:

Medicine is undergoing a radical transformation, from 20th-century medicine to 21st-century medicine: 20th-century medicine uses small data sets—like looking at sodium and potassium but not the genome or metabolome or epigenome—to attempt to diagnose very complex illnesses in very complicated organisms—human beings. 20th-century medicine makes a diagnosis of what—Alzheimer’s or cardiovascular disease or hypertension—without understanding why. 20th-century medicine uses a one-size-fits-all, monotherapeutic approach, and has been largely unsuccessful in treating chronic illnesses such as Alzheimer’s disease, other neurodegenerative conditions, cancer, and cerebrovascular disease.

21st-century medicine is completely different: larger data sets are used to identify network changes that characterize chronic illnesses, revealing the “why” for each person—this is the etiodiagnosis. Prevention and early symptomatic approaches are emphasized. Addressing the cause of each condition in a comprehensive and personalized, programmatic way leads to improved outcomes, and each program is repeatedly optimized over time, to ensure sustained improvement.

Actually, the curmudgeon in me can’t help but point out that it has yet to be demonstrated convincingly that “precision medicine” or “personalized medicine” actually does produce better outcomes. One can’t help but point out the example of the SHIVA Trial, where precision medicine for cancer was tested against standard of care and failed to do better. Precision medicine might some day be shown to be as great as Bredesen claims, but it hasn’t yet. More importantly, we have no way of knowing if what Bredesen is doing is really precision medicine and a lot of indications (the supplements, the exercise, the many labs) that it is not.

Finally, you too can learn the modified MEND™ Protocol/The Bredesen Protocol if you want. MPI Cognition offers 4 day training programs that “cover all aspects of The Bredesen Protocol, from the scientific data and background to the key factors for success to the critical tests and follow-up to the best methods for sustaining success.” I wonder how much CPI Cognition charges for this training course. Whatever the cost, though, it’s clear to me that Bredesen’s latest case series falls far more into the category of marketing literature than scientific literature.

oracknows Thu, 06/23/2016 - 21:43

Tags

Clinical trials

George Washington University

alzheimer's disease

clinical trial

Dale Bredesen

http://www.ncbi.nlm.nih.gov/pubmed/20377818

proprietary computer algorithm

I missed that bit the last time around.

Granted that medicine has a different culture from my field, as well as IP issues that don't arise in my field (i.e., studies involving commercial products under development), but in my field, that wouldn't fly. The major journals in my field expect you to provide source code on request, for the obvious reason that it allows anyone so inclined to reproduce your results. It helps that data in my field is normally publicly available, which is obviously impractical (or even illegal, due to HIPAA and similar laws) in many medical studies.

I notice that, once again, he did not get IRB review for this study, just like his 2014 paper.

I see, in his writings, something not uncommonly witnessed when working with dementia patients, word salad.
"...as well as epidemiological studies of various monotherapeutic components of the overall program."
OK, if it's monotherapy, how does it have multiple components? That'd be polytherapy.
So, under his daffynition at the outset, I'm on a half dozen simultaneous monotherapies, at the same time as well.
Or something.

Just one more shyster in a field that embarrass used car salesmen.

I see, in his writings, something not uncommonly witnessed when working with dementia patients, word salad.

TBF, word salad isn't exclusively a symptom of dementia. For a fictional example, see Gabby Johnson's "authentic frontier gibberish" in Blazing Saddles. In the real world, it crops up often in bureaucratese (where it frequently takes the form of "buzzword bingo") and political speech (Sarah Palin being the most notorious but hardly the only US example).

Of course, I don't know Dr. Bredesen well enough to rule out dementia, but there are enough problems with the study as it is. We don't need to invent speculative reasons for distrusting it.

@ Wzrd1

Maybe he meant "different studies, each focusing on one or more single-component therapies".
Um, I'm reaching, here. I agree that's not clearly worded.

To my shame, packing sexy buzzwords and big scientific words into a grant request or an article introduction is something I have seen done by different colleagues (and sometimes I added my own layer).
Occasionally, the result was word salad.

It's the result of overdoing it and lacking a good proofreader. It's more likely to arise in another language, or if one doesn't have much to say. Something about dazzling them with brilliance or dazing them with BS.

Well, it could also be that me and my colleagues are totally bonkers. Sometimes I wonder.

"21st-century medicine is completely different: larger data sets are used to identify network changes that characterize chronic illnesses, revealing the “why” for each person—this is the etiodiagnosis." BS on so many levels!
He should read Stephen Jay Gould's The Median is Not The Message. Where in that cloud of thousands of points in the data set is the individual waiting for a 'personalized' treatment plan? Are they in the centre of the distribution? The tails? And if the data set is based on BS relationships between variables, what then? No worries, we have a great line of unicorn saddles on special this week!

@JDK #6, now now, I get a personalized treatment plan from my allopathic doctor.
A specific set of blood pressure medications, adjusted and titrated to maintain my blood pressure to a humanly survivable blood pressure level, thyroid suppression medication that is also titrated to keep my thyroid hormone levels at a humanly survivable level, etc.
All treatment is individualized to a degree, as each patient is indeed different, with different medical conditions and their own physiological idiosyncrasies.
What the quack is doing is playing on the notion that patient care is not individualized upon patient need, throwing buzz words in to not dazzle with the brilliance of a new treatment method, but baffle with the bullshit.

I appears that Orac is unwilling to Step Right Up to 21st Century Medicine.

Proprietary, secret squirrel, un-peer reviewed technology shows ground breaking results.
Theranos anyone?

My father died from dementia (it is not what is on death cert) 3 years ago and I can see how a scam like this would appeal to many people. Mom whished for nothing more than 2 more months so they could reach their 60th anniversary.

We didn't know or see the signs of dementia early, so education of people is very important. I have a younger brother that to me is showing signs of early onset dementia. He has many of the factors that may lead to dementia: obese, diabetic, inactive, out of shape, and doesn't read or perform other intellectual actives.

"Proprietary, secret squirrel, un-peer reviewed technology shows ground breaking results."

Heh! But meteorites and shovels have hard data to prove that they do it better.

At the core, I only have three "scientific" objections to this protocol: one is that it is quite complicated so that it would be difficult for someone with memory impairment or their caregiver to follow, two it has not been determined which elements of the protocol may be most effective (some such as hormone replacement therapy may be counterproductive for some individuals), three it may be ineffective or much less effective for someone with mild to moderate Alzheimer's disease.

The key pieces to Alzheimer's disease is laid out in the following:

"Malinow’s team found that when mice are missing the PKC alpha gene, neurons functioned normally, even when amyloid beta was present. Then, when they restored PKC alpha, amyloid beta once again impaired neuronal function. In other words, amyloid beta doesn’t inhibit brain function unless PKC alpha is active."

The data indicate that... PKC activation mediates ONOO- [peroxynitrite] generation, which results in the oxidation and depletion of glutathione...

The hippocampi – the brain centres for learning and memory – are one of the earliest regions to be sabotaged by Alzheimer’s pathology. Our data revealed that GSH [glutathione] levels plummet in the hippocampi of patients with Alzheimer’s as well as those with MCI.

A natural scavenger of peroxynitrites, rosmarinic acid, protects against impairment of memory induced by Abeta(25-35).

Reducing stress (yoga, meditation, a walk in the woods, etc.), consuming less sugar, salt, and carbohydrates, reducing exposure to environmental toxins, treating chronic infections, etc. all reduce protein kinase C activation. But it is not a matter of simply inhibiting protein kinase C (which as the disease progresses likely remains high in only those with neuropsychiatric problems). The key is as the brain's own antioxidant--glutathione--is exhausted--external antioxdiants must be used in its place. Several antioxidants were used in this protocol but likely not the most effective ones--particularly as the disease progresses. Here are links to clinical trials in which peroxynitrite scavengers were used to treat mild to moderate Alzheimer's disease.

http://www.ncbi.nlm.nih.gov/pubmed/22780999

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3659550/

This protocol while not perfect is a step in the right direction because much of it addresses the risk factors and likely cause of Alzheimer's disease (oxidative stress).

I am afraid that much of the skeptical community is so caught up in its certainty about the superiority of its belief and so upset with various "heretics" that this community is unable to rationally evaluate the actual science. Here, is how an anonymous reviewer presented the evidence for how to treat Alzheimer's disease:

[Clinical trials with over-the-counter supplements have concentrated either on items which suppress inflammation, or on antioxidants which scavenge oxygen derived free radicals. Most of these items have proved to be worthless in the treatment of Alzheimer's disease. Similarly most drugs used to treat Alzheimer's disease do little to slow the deterioration, but instead offer a mild temporary
symptom relief. However, evidence has been accumulating that the primary driver of Alzheimer's disease is a nitrogen derived free radical called peroxynitrite, which may mediate both amyloid and tau accumulation as well as their toxicity.
Excellent results have been obtained with peroxynitrite scavengers, with reversals of Alzheimer's disease in human clinical trials being repeatedly demonstrated. IMHO, the only thing which may be preventing the abolition of
Alzheimer's disease is the mental inertia of scientists, as well as the bureaucrats who fund them. Unfortunately, most bureaucrats keep throwing money into repeatedly testing discredited interventions, while ignoring successful
ones. Common sense is anything but...]

Orac,
With the illustration at top, are you saying losing to Alzheimer’s is as inevitable and natural as deciduous trees losing their leaves in the fall?

Lane, don't forget to mention you pet therapy for AD is aromatherapy with rosemary oil. That should boost your credibility around here!

Note that the paper reports finding dramatic hippocampal enlargement in patient 1 following treatment as evaluated by quantitative MRI, but shows no photo of the brain scan. Your best result and you don't show it? That seems rather odd.

Thanks for the add’l post.

First, we’re of course talking about Alzheimer’s here, not autism, so you can make that correction in the third sentence. I guess your cheerleaders don’t read that closely. ;)

I largely agree with what the neurologist Steve Novella from SBM wrote, who you cite, which is that “While the current case series is certainly provocative, I do not think it is reasonable to use this level of evidence to make clinical claims… What we need now is a randomized double-blind placebo controlled trial.” To me, it seems the researchers understand this, although maybe not some of the people at companies seeking to promote/commercialize it (especially unaffiliated ones).

You write that in the original research paper he’s laying down “woo babble”, but I just don’t see it as that egregious. For instance, you mention soon after the citing of “connectomic” studies, where he cites a reference: “http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4546454/pdf/oncotarget-06-1…” The reference is a 25+ page peer-reviewed paper (Oncotarget, Impact Factor 6.359, ~top 5% of all journals) he co-authored with a UCLA scientist that described a new theory for Alz, and including potential pharmaceutical and other interventions that resulted from this work. Seems pretty reasonable, even interesting, no?

Your point and/or Steve Novella’s point about patient selection is definitely valid. One reason I doubt it is highly cherry-picked though is b/c I tend to think he doesn’t operate a really high-volume clinical practice. Thanks for bringing up the pancreatic cancer example, which of course is another devastating condition (two colleagues/mentors of mine have passed away from it in the last 3 years). I think the case series analogy you describe here is relevant, but the devil is in the details, and the depth and breadth of research supporting the recommendations here appear in most cases to be far more substantial.

You write off the characterization of Alz subtypes, due to one element of it having a loose connection to the charlatan you describe, but the theory was described more clearly in a different paper: http://www.ncbi.nlm.nih.gov/pubmed/26343025, which it seems you haven’t seen. I’m not going to champion this paper, b/c it looks like preliminary evidence based on the same case series (which he appears to be getting a lot of use out of… :), rather than a really exhaustive analysis from thousands of patients. He cites a couple relevant papers (refs 2 and 3 in particular), including the FINGER study, a RCT involving 1,260 enrolled patients, but in digging into this it doesn’t seem to provide clear evidence for any clear subtypes. So I tend to agree this is more of a theory at this point. It appears another thing he wants/needs to study through a larger RCT.

The snarky “natch!” comment related to the journal doesn’t seem appropriate. As you’ve already described in your last article the impact factor is >6, (6.432), so it’s a decent journal. Also, take some time and look at the editors and other articles. These are quality researchers and papers in the aging field, and many have spent decades trying to distance themselves from the joke and embarrassment of all the “anti-aging” garbage that is out there.

Also, I found it interesting that the FINGER study (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60461…) cited within that paper appears to be a RCT again in 1,260 patients that has already demonstrated benefit of a lot of the non-controversial stuff included in this regimen, like diet/nutrition, exercise, cognitive training, and also somewhat active management of metabolic and vascular risk factors. For example, the intervention group had check-ups at 3, 9, and 18 months, compared to the controls just getting advice at the beginning of the trial. So I think it’s reasonable to conclude that the FINGER study is somewhat analogous, and more like a program (buzzword translation:”programmatic”), and that it got decent results, although not breathtaking ones, in a RCT.
One thing you mention struck me is that you’re criticizing someone for measuring anything that hasn’t “been shown to have a causative role in these diseases”. It seems like a very high standard, especially for Alz. Would you or anyone else point me to all the markers that are causative for Alz? Are there any that are causative, and also modifiable?
Yes, “Treat the patient, not the lab values.” That’s one of the reasons I liked this preliminary study… demonstrable improvement in functional outcomes, albeit in a small group of patients and requiring follow-up. If you think a case series and approach like this is bad, let’s not forget how many thousands of papers on Pubmed of cell line development, artificial mouse models, GWAS, etc… most of it good, solid, honest work, but let’s face it… unfortunately most of it is also a million miles from an Alz cure. We should thank our lucky stars (!) for physician researchers who have the time and wherewithal to think and also do innovative research on their own (which I consider distinct from finding the time to run an industry-sponsored trial).

The “curmudgeon” in you can’t help but point that precision/personalized medicine doesn’t produce better outcomes. I agree with this. I imagine even Craig Venter and Lee Hood would agree with you to a significant degree, too, though they both are affiliated with companies that offer (expensive) personalized wellness programs (HLI’s Health Nucleus and Arivale Health, respectively). I’m not sure how it is pitched to people, but it should be pitched for what is, some recommendations grounded in clear evidence, but many parts still very much a science project.

My major gripe remains that I think these articles don’t do a good job separating the pretty intriguing but early-stage research from the more questionable ways (mostly unaffiliated) people are marketing it.

He’s not the first researcher to invent and use some buzzwords, or to use somewhat grandiose language talking about their work. If he didn’t, all the researchers doing something useless like making new iPS cell lines of hippocampal neurons using CRISPR would get all the funding.

One thing I don't understand that you think Alzheimer is inevitable.
What does the top tree figure means?

@Wzrd1 #3

“…as well as epidemiological studies of various monotherapeutic components of the overall program.”

You're misunderstanding. He obviously means he based certain individual components of the program on epidemiological studies. In other words, he selected certain components due to studies that showed a correlation of some factor, or some marker that a component influences, with a good prognosis/outcome in Alz.

It's not as good as having a RCT with positive results to support (but if this was the threshold for Alz, it obviously would be very slim pickins').

I looked at the reference he cited (http://www.ncbi.nlm.nih.gov/pubmed/23703924). It's a paper he co-authored paper, titled "Next gen therapies for Alzheimer's disease" (EMBO Molecular Medicine, Impact Factor 8.245). It's a decent read though I don't see any clear examples of this there. But I think even the non-controversial diet and lifestyle stuff would fall in this category, i.e. supported by epidemiological work primarily (although the FINGER study I mentioned does provide some evidence in a large RCT).

@Bobby Brooke, #17, so, he went through the data and for each prospective issue found in Alz, found a prospective treatment and combined them.
Unless those specific issues are proved causative for the condition, it isn't treatment, it's throwing spaghetti against the wall to see what might stick and claiming success.
This isn't Pasteur and Roux, it's Chef Boyardee, with an odd report that doesn't include its star evidence, such as the brain imagery. To say that I'm dubious is to put it mildly.
As one who lost my cousin's husband and soon, a cousin to the disease, a man I immensely respected, this is disheartening.

@ Wzrd1 #18

Yes, this was listed as one of the ways he found prospective treatments/components.

"Unless those specific issues are proved causative for the condition, it isn't treatment"... Would you let me know the "issues" that you know of that are causative for Alzheimer's? Are there ones you know of that are also modifiable? I'm curious if there are any, so it seems like a very high standard for Alz.

In the U.S. at least, doctors decide what is treatment, and they have plenty of discretion, including to use drugs off-label, and also to use things where they feel there is sound judgment behind, they're reasonably safe, etc.

But I agree with your sentiment somewhat here... especially with regards to those people/groups who might be "selling" the treatment, while still proven, and especially if it's not disclosed as more investigational. It should be noted also that the MPI Cognition company actually appears to be trying to educate/train doctors on this (which Orac left out, only highlighting the direct-to-consumer/patient marketing).

In case it hasn't become obvious by now, I like Chef Boyardee... (the approach, albeit yes it is a shotgun approach, and yes it is obviously quite different from monkeying around with molecular mechanisms).

Sidenote: the researcher behind this works looks at molecular mechanisms, too, in case you haven't seen this interesting paper on APOE: https://www.sciencedaily.com/releases/2016/01/160128155753.htm

I'm sorry to hear about your family members.

If nitro-oxidative stress is the cause of Alzheimer's disease, then most of this protocol should have an impact on Alzheimer's disease at least at its earliest stages.

First the case itself:

"The reaction product of nitric oxide and superoxide, peroxynitrite, is a potent biological oxidant. The most important oxidative protein modifications described for peroxynitrite are cysteine-thiol oxidation and tyrosine nitration."

Cysteine oxidation and/or tyrosine nitration causes the following damage in Alzheimer's disease: disabling of receptors involved in short-term memory, sleep, smell, mood, alertness, and social recognition, inhibition of the transport of choline and the conversion of choline into acetylcholine (acetycholine is required for the retrieval of short-term memory), reduction in the flow of blood and the transport of glucose in the brain which can lead to delusions, prevention of the regeneration of neurons in the hippocampus, and the death of neurons.

Cysteine oxidation can be partially reversed by compounds that donate hydrogen atoms and peroxynitrite can be scavenged by these same compounds. When peroxynitrite is scavenged it produces water and water is a putative de-nitrating agent. Thus some (but perhaps not all) of the damage described above can be reversed.

There is a long list of factors that can contribute to nitro-oxidative stress and thus the onset of Alzheimer's disease: the ones relevant to this study include sleep apnea, stress, chronic infections in the brain (including potentially oral infections), and a high carbohydrate diet. Addressing these risk factors for Alzheimer's disease may potentially slow down the disease at least at the earliest stages. Antioxidants such as the ones used in this protocol can be used at any stage to at least slow down the progression of the disease. The most effective ones are called methoxyphenols such as curcumin (whose value is reduced by its poor bioavailablity), eugenol in various essential oils via aromatherapy, and syringic acid and ferulic acid in panax ginseng.

For those who like chemistry:

"The structural features of curcumin that can contribute to the antioxidant activity are the phenolic and the methoxy group on the phenyl ring and the 1,3-diketone system. Moreover, the antioxidant activity of curcumin increases when the phenolic group with a methoxy group is at the ortho position [16, 17]. The orthomethoxy group can form an intramolecular hydrogen bond with the phenolic hydrogen, making the H-atom abstraction from the orthomethoxyphenols surprisingly easy [18]. The H abstraction from these groups is responsible for the remarkable antioxidant activity of curcumin."

I understand very personally the devastation that Alzheimer's disease causes, but I also sense how potentially close effective treatments for the disease are.

@ Lane Simonian #20

For the record, the 2014 paper w/ the regimen lists one component related to antioxidants, and that was based on this work from UC Irvine, describing how a medical food cocktail showed beneficial effects in a mouse model: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2984445/

That said, from a quick look at the description of which people adhered to what, it doesn't seem clear that any of them took any at all.

The difficulties inherent in animal models are quite well displayed in the abortive TGN1412 trial.
Looked great on paper, worked great in animal models, harmed every test subject who received the drug - badly.
Models can help narrow down pathophysiology, but are far from highly effective in predicting pharmaceutical effects outside of their species.

@ Bobby Brooke #21. Several of the participants took antioxidants, including curcumin, melatonin, vitamin D3, bacopa monniera, Aswagandha, coconut oil, resveratrol, coenzyme Q10, and methylcobalamin.

http://www.impactaging.com/papers/v6/n9/full/100690.html

@Lane, #23, interesting that curcumin is mentioned.
Some bill it as a panacea, of which I am dubious.
However, I'll admit to watching tumeric used orally for an asceptic skin condition that confounded our physicians, to excellent effect. We tried pretty much everything in the book and doctor's experience in both cases, to no avail. The local "witch doctor", for a lack of a better term used tumeric and black pepper. He related how tumeric worked by itself, but slower.
Further research on regional practices revealed the same treatment for this ailment, blocked, "tunneling" pores, which then behave like a sterile boil.
Apparently, it was a local affliction, even the locals suggested it was familial and hence, genetic.
Doctors and my senior guys theorized that the piperazine may induce inflammation, facilitating the therapeutic agent from the tumeric. Studies are ongoing, begun around 2008, so replication is conducted as a matter of course in DoD circles, release after.
One of a handful of interesting finds over the decades, some later became known pharmaceuticals, with known dosage and purity, rather than a toss of the dice with variable sourced plants.
See my foxglove argument above, vs digoxin. I'll go with prescribed digoxin every time that I can get it, if I need it.
Just as, if my guys suffered a nerve agent poisoning event, I'd not have them chew tomato plant leaves and smoke jimson weed, I'd give them enough atropine to counter initial symptoms, then 2Pam chloride to clear bound agent from the receptors. Controllable, replicable dosage defeats random sourced, variable dosage plants.
An autoinjector or even a vial beats a truckload of plant matter and worrying about dosage for each and every patient.
Mass casualty events suck badly enough to begin with, adding random pharmaceutical events just lowers the survival rate.
IED's did enough of that to begin with, as my tinnitus can attest to. -45 db worth of it in hearing loss.

Small trial succeeds using systems approach to memory disorders

I am at a loss to see how surrounding a small trial with wibble and calling it "systems approach" makes it anything more than a small trial, i.e 10 anecdotes with no controls or skepticism of any kind.

"Impact Journals" are in Beall's list as a predatory publisher, no meaningful peer review. This should make a difference for Science Daily if they want to be anything more than a pukefunnel for pimping press releases.

@ HDB
The editorial board is not really consistent with a predatory publisher:
http://www.impactaging.com/editors.html
Have you any explanation?

Your point and/or Steve Novella’s point about patient selection is definitely valid. One reason I doubt it is highly cherry-picked though is b/c I tend to think he doesn’t operate a really high-volume clinical practice. Thanks for bringing up the pancreatic cancer example, which of course is another devastating condition (two colleagues/mentors of mine have passed away from it in the last 3 years). I think the case series analogy you describe here is relevant, but the devil is in the details, and the depth and breadth of research supporting the recommendations here appear in most cases to be far more substantial.

If the manuscript doesn't include a detailed description of the selection criteria and exclusion criteria, I am not inclined to give the authors the benefit of the doubt. That is such utterly basic information that is absolutely necessary to evaluate the series that its omission to me is an enormous red flag. As for Aging, whether it's predatory or not, clearly there is a problem with its peer review system if it allows articles like this to be published without such basic information. Ditto the lack of detail about the actual protocol and algorithm that was used to determine each patient's treatment. Here's where I disagree with Steve Novella. I don't think the data in this paper warrant an RCT. Bredesen needs to go back to the drawing board and either publish an update to this case series with sufficient detail to allow it to be evaluated or do a proper case series.

@ Orac
I don't doubt that there was a serious problem in the peer review of this article. But I can find many similar cases in journals from "non predatory" publishers. Hence the question, where does this information about predatory publishing comes from, or, alternatively, how could a predatory publisher get a prestigious editorial board?

@Wizrd1 #23 Thank you for all the interesting information and valid points. Some spices can cause inflammation, but the most common argument for using black pepper with curcumin is to increase the absorption of the curcumin. Several researchers are trying to find other ways to increase the absorption of curcumin for the treatment of Alzheimer's disease, but I have not seen any updates for awhile.

I take curcumin for a Celiac-like disease that may have been caused by pesticides. The nice doctor originally diagnosed it as ulcerative colitis and wanted to prescribe prednisone, but I had seen the efffects of prednisone on my father so I declined. As it seems, the same compound--peroxynitrite-- that causes leaky gut also appears to cause a leaky brain. My own experience, though, has been that the curcumin has helped better with a "leaky gut" than with a "leaky brain".

There are a number of natural products that have been synthesized into drugs. In most cases (perhaps all cases), if I had to I would take the medicine rather than the natural product. The problem with Alzheimer's disease is that none of the drugs are effective (although they may provide symptomatic relief for awhile).

I have seen claims that a more effective form of eugenol has been synthesized, but as far as I know it has never been tested for Alzheimer's disease.

When I read that rosmarinic acid improved memory in mice, I began to use aromatherapy for my mother (it turns out the eugenol is the more effective antioxidant compound). With aromatherapy, she recognized her home again, stopped having delusions, could recognize objects (like a rose and sugar), could remember and spell her name, and became much more alert and aware. Her short-term memory improved slightly and she became a little more lucid. She was probably late stage 6 Alzheimer's disease when we began aromatherapy. She lived five more years, steadily improving, before dying of other causes.

My grandfather was a naturopath and he treated almost everything that way. My mother almost never went to the doctor. Ironically, the one prescription drug she did take-- Fosamax--may have contributed to her Alzheimer's and to the severe esophagitis and heart problems that would eventually take her life. I am not a naturopath nor am I opposed to modern medicine; I look into both camps to try to find what will work.

@Lane, only one thing. If one had a leaky gut, one would have fecal coliforms in one's blood. That would be septicemia and quite life threatening.
The other potential leak would be into the peritoneal cavity and again, it'd result in a life threatening infection and all of the symptoms of peritonitis would be present.
There is some weak evidence that one's intestinal flora and fauna may contribute to some disease processes, but the evidence is extremely weak.

As for the use of prednisone, I know quite well the effects of short term and chronic administration of the drug. Indeed, I carried injectable prednisone in my military treatment bag. My wife takes it chronically for her Lupus. Better with it than without it!

where does this information about predatory publishing comes from, or, alternatively, how could a predatory publisher get a prestigious editorial board?

I can only say that Jeffrey Beall has compared the publisher against his criteria and seen enough evidence of predatory or vanity practices to include it in his list:
https://scholarlyoa.com/publishers/

...but it hasn't been a sufficiently egregious or entertaining case for him to devote a separate blog-post to it.

The key question about a star-studded editorial board is whether those prestigious researchers ever get to do any editing (academics are known to accept flattering invitations without looking too closely at the source). If indeed they are reading submissions, and rejecting them or farming them out to peer reviewers, so the journal has become genuine whatever the original intentions of the publisher might have been, then Beall is amenable to reclassifying it.

But I can find many similar cases in journals from “non predatory” publishers.

All too true.

With aromatherapy, she recognized her home again [...]

Could it be that stimulating the olfactory senses of your mom triggered back memories?
We tend to focus on visual and auditive memories, but the human sense of smell is also quite good at building souvenirs.

More likely it's cognitive bias. He's evaluating the results of his own putative therapy.

@Wzrd1, #31 (I think that I did it right this time).

I suppose leaky gut is a term that I and others use too loosely. Tissue damage and intestinal inflammation might be better terms. I found an interesting parallel however between the protocol for my condition and the MEND protocol.

http://sanjosefuncmed.com/intestinal-permeability-clinical-unwinding-le…

I have the luxury of avoiding the use of prednisone. I understand that not everyone has this luxury. I wish you and your wife the best.

In regards to aromatherapy, there is a strong connection between smell and memories, but in my mother's case the main effects were in place recognition and time recognition. After a month of aromatherapy, she asked why have you been giving this to me everyday for a month. She also noticed that I had moved an object on her shelf. My sister and I took turns taking care of her. She once told me this house (my sister's house) had an upstairs and a downstairs. I asked with surprise how did you know that. She said, "I have been living here for awhile."

Acetylcholine in the the hippocampus plays a critical role in spatial recognition object recognition, and sense of time. The compounds in essential oils are almost directly inhaled into the hippocampus via the nose. They begin to reverse the oxidation/nitration of choline transporters, choline acetyltransferases, and the muscarinic acetylcholine receptors. A person thus has more acetylcholine and certain aspects of their memory improve.

Episodic memory and the ability to sort out information in part at least includes parts of the brain other than the hippocampus. My mother's ability in these areas did not improve substantially.

I neither invented the oxidative stress hypothesis for Alzheimer's disease nor aromatherapy for the treatment of Alzheimer's disease (although I began the treatment based on the possibility that rosmarinic acid could improve memory; most of the studies on aromatherapy for Alzheimer's disease came out later). I will take a bit of the credit for putting a vast amount of research into a little different light and grin and bear the scorn, but in the end I am only slightly adding to the work of some very good scientists.

The compounds in essential oils are almost directly inhaled into the hippocampus via the nose.

You don't say.

Lane, you are a crank.

Oh, dear L-rd:

[T]he plaque is likely neuroprotective because it inhibits the formation of hydrogen peroxide which may be at the heart of prion diseases.

I spy with my little eye something that begins with the letter 'c'.

Anyway, Lane, I just reexamined your comment 12 expecting to find some sort of rodent payload, but I was distracted by trying to figure out where the different parts of the cut-and-paste job started and ended, as compared with your own prose, and didn't even bother to around the corner to get PMID 17420060.

If you can't actually put together something coherent in your own words, at least get the quotation marks consistent and put the citations immediately after the quotes.

^ "to go around the corner"

(campus hotspot)

Here is one article suggesting that amyloid plaques are neuroprotective by cutting off the production of hydrogen peroxide:

http://www.jbc.org/content/280/43/35789.abstract

I will try to put it together as coherently as possible. Amyloid beta (either the amyloid precursor protein or amyloid oligomers) do not damage neurons unless protein kinase C is activated. When protein kinase C is activated it leads to the formation of peroxynitrite and caspase 3 (an enzyme linked to the death of neurons) and it leads to the depletion of glutathione--a critical antioxidant in the brain. Perhaps most importantly, glutathione scavenges peroxynitrite; without glutathione there is little to no protection of either neurons or maintenance of acetycholine for short-term memory.

http://www.ncbi.nlm.nih.gov/pubmed/8940610

The only compounds that have partially reversed memory loss in Alzheimer's disease are specific peroxynitrite scavengers (i.e. specific antioxidants. The chart in the link below helps put a picture to the words (ONOO- is peroxynitrite and GSH is glutathione).

http://www.frontiersin.org/files/Articles/131867/fncel-09-00091-HTML/im…

The Kegg pathway for Alzheimer's disease is also instructive (especially the lower half).

http://www.genome.jp/kegg-bin/show_pathway?hsa05010

I will add the first step of Alzheimer's disease to the mix. People with high levels of myo-inositol are more likely to develop Alzheimer's disease.

http://www.docguide.com/myo-inositol-n-acetylaspartate-are-sensitive-bi…

The factors that contribute to high myo-inositol levels are high glucose levels (due to a high carbohydrate and high sugar diet, for instance), a high salt diet, and Down syndrome (individuals with Down syndrome have an extra chromosome containing the sodium/myo-inositol co-transporter). By age forty people with Down syndrome have the supposed biomarkers for Alzheimer's disease: amyloid plaques and hyperphosphorylated tau, but not all go on to develop Alzheimer's disease. Individuals with Down syndrome have high levels of hydrogen sulfide--which itself may contribute to mental impairment--but which protects against Alzheimer's disease because hydrogen sulfide is a peroxynitrite scavenger. One can have both plaques and tau tangles in their brains, but as long as peroxynitrite is being sufficiently scavenged, a person will not develop Alzheimer's disease. On the other hand, if intracellular calcium release is inhibited or blocked, a person can have Alzheimer's disease with little to no plaques and relatively few tangles.

Last chart this time showing the place of myo-inositol in the chain that leads to Alzheimer's disease:

http://tmedweb.tulane.edu/pharmwiki/lib/exe/fetch.php/lithium.png

The types of receptors that act upon the myo-inositol "product" phosphatidylinositol 4,5 biphosphate (PIP2) and lead to the activation of protein kinase C are receptor tyrosine kinase, g protein coupled receptors, ionotropic receptors (such as nicotinic acetycholine receptors), and metabotropic receptors (such as certain glutamate receptors). These are the receptors that balance growth and death in the body. Overactivation of these receptors can lead either to excessive cell growth (cancer, for instance) or excessive cell death (Alzheimer's disease, for example).

The number of factors that can activate these receptors are numerous: they include chronic bacterial, fungal, and viral infections, high fructose corn syrup, certain drugs (such as Fosamax and chronic use of acetaminophen), pesticides such as DDT, Agent Orange (due to dioxin) and Roundup (due to the polyethoxylated tallow amine adjunct), various air pollutants (including diesel fumes, particulate matter, and carbon monoxide), aluminum fluoride, sodium fluoride, industrial solvents such as toulene and benzene, moderate to heavy smoking, psychological stress, and various genes (APOE4, presenilin gene mutations, amyloid precursor protein mutations, for instance). Alzheimer's disease is not simply a matter of aging, it is a matter of how many factors can contribute to the onset of the disease. The MEND protocol addresses some of these issues.

Some scientists don't consider me a researcher. But you don't only have to invest the time in the lab, you have to invest the time reviewing the literature. By doing the second, you come up with a better understanding of the causes and potential treatments for Alzheimer's disease.

Hi Lane, "various air pollutants (including diesel fumes, particulate matter, and carbon monoxide), "

Could you describe the process by which particulate matter and carbon dioxide, get into the brain?

The author of this article clearly and precisely discusses the routes by which nanoparticle air pollutants enter the brain, particularly via the nose and lungs.

https://student.societyforscience.org/article/nano-air-pollutants-strik…

The section of the health effects of air pollutants on children in Mexico City is of particular interest to me as I am a Latin American environmental historian. Children exposed to high levels of air pollution in Mexico City have diffuse plaques and tau tangles in their brain and exhibit subtle signs of cognitive impairment. But when given cocoa--a peroxynitrite scavenger--their cognitive function slightly improved.

http://www.ncbi.nlm.nih.gov/pubmed/23986703

Oxidants (particularly various air pollutants and industrial solvents) working via inhalation are one of the routes to Alzheimer's disease. Antioxidants --such as eugenol and linalool in various essential oils via inhalation aromatherapy--are likely one of the routes partially out of Alzheimer's disease.

The 2016 paper referenced can be found here http://www.aging-us.com/article/9R5JsRe8k4Jq7uTXj/text . The publication linked to in questioning Bredesen's history (http://retractionwatch.com/2013/10/31/he-said-she-said-journal-of-neuro… ) is very weak material with which to suggest a questionable history, and seems like a shameful condemnation.
The main complaint about the 2014 study is largely overcome in 2016 by the provision of actual cognitive test results and/or analytic brain size or chemistry measurements. However the possibility of a sample selected for successful cases only remains valid.
The concern about a more holistic approach to tests and diagnoses, followed by tailored treatment is misplaced. For 6 of the 10 patients several diagnostic blood test results are given, and there is no common pattern, which clearly supports the idea that there can be many different combinations of systemic chemistry problems that can lead to AD, meaning no monotreatment is likely to be effective in any case and for sure not in most cases. Treatment must be tailored to the specific issues. Patient #9 is especially interesting - none of the items measured are out of the normal range and she is APOE 3/3, so why does she display any cognitive impairment? It seems likely that the problem that triggered the impairment has now "healed", and she might have been getting better even without the MEND treatment.
I think ORAC needs to develop a more open mind and recognize the Bredesen is probably onto something very important, but still in very early days.

This may shed some light on Breseden's selection criteria, if indeed there are any, for various approaches. It is a horrifically defective paper that should never have passed peer review:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4586104/

It's also quite interesting to see that Breseden is now hawking a book in the company of other known quacks such as "Yale's" own David Katz, with whom SBM has tangled before.

event.awakeningfromalzheimers.com/trailer-2c/

The MEND™ protocol for Alzheimer's disease: Functional medicine on steroids?

oracknows — Fri, 17 Jun 2016 05:30:27 +0000

The MEND™ protocol for Alzheimer's disease: Functional medicine on steroids?

A recurring theme of this blog is to shine a light on what I like to call “quackademic medicine.” I didn’t invent the term, but I’ve made it mine. Basically, quackademic medicine is a term that very aptly describes what’s going on in far too many academic medical centers these days, which is the infiltration of pseudoscientific medicine and outright quackery in the form of “complementary and alternative medicine” (CAM). Of course, the more recent term for CAM is now “integrative medicine,” which was coined to imply the “integration” of alternative medicine with science-based medicine as though they are equals. Thus, there are academic medical centers that embrace acupuncture, reiki, and naturopathy, the last of which includes homeopathy as an integral part of its curriculum and skill set.

Among the centers of quackademia, of which there are far too many in existence, George Washington University is among the most egregious when it comes to embracing pure quackery. The last time I discussed GWU, I noted that the Center for Integrative Medicine at the George Washington University Medical Center (GWCIM) offers services that, charitably, be called pure quackery: acupuncture (of course!), chiropractic, craniosacral therapy, infrared light therapies, glutathione infusions, Myers’ Cocktail, naturopathy (again, of course!), reiki, intravenous high dose vitamin C, and genetic profile results that include “customized interpretation of 23andme.com genetic profile results with specific accent on methylation and detoxification profiles.” Some of these are quackery. Some are “rebranding” lifestyle interventions as somehow “alternative” (and therefore much more hip). Some blur the lines between the two, such as “functional medicine,” a branch of CAM that combines “wholistic” medicine with a whole lot of lab tests and supplements to correct abnormal lab values. The Cleveland Clinic is especially enamored of functional medicine.

Now I learn that GWCIM has recently added another questionable treatment to its already expansive list of questionable protocols. No, the protocol to which I’m referring is not homeopathy, craniosacral therapy, or high dose intravenous vitamin C. The kindest way to describe it is experimental, even though it seems to be offered to anyone without a clinical trial. As it is experimental, it is unproven. It’s also based on pretty thin gruel as far as clinical data goes and resembles to me the premature use of 23andme genetic profiles to guide care before we even know what these profiles mean. No, strike that. It reminds me of functional medicine:

Muses Labs announced today that it has partnered with the George Washington Center for Integrative Medicine (GWCIM) to offer the MEND™ Protocol to patients located in Washington, DC. This agreement allows individuals with pre- and early-symptomatic cognitive decline, as well as mild Alzheimer’s disease patients, to benefit from the MEND Protocol via the Center’s Mental Health program operated in collaboration with the George Washington University Memory Clinic.

The MEND Protocol is a data driven, technology enabled, personalized methodology to correctly identify and simultaneously treat the dozens of pathology drivers of age-related cognitive decline. The MEND Protocol is designed to help patients who are beginning to have symptoms of age-related cognitive decline, those with a family history of dementia and patients with mild Alzheimer’s disease. The Protocol recommends optimal medical interventions personalized for each patient and has the potential to improve memory and cognitive function. The MEND Protocol is an emerging methodology that reflects a new approach to addressing complex diseases.

The MEND™ Protocol is a treatment for Alzheimer’s disease marketed by Muses Labs. I always become very suspicious when I see marketing materials that make claims like this:

MEND™ Protocol simultaneously applies multiple medications and lifestyle changes in a highly-personalized manner to attempt to halt and reverse mild cognitive impairment (MCI) and early stage Alzheimer’s disease. MEND Protocol utilizes existing FDA-approved drugs, supplements, lifestyle changes, and medical markers and tests in a novel manner. Personalization of the protocol depends upon an individual’s genome, medical test results, comorbidities, current medications, medical history, and other inputs.

MEND Protocol is designed to address the active underlying pathways for Alzheimer’s disease including metabolic issues, toxicity, inflammation, and mitochondrial damage. Due to the complexity of the personalization process, the Protocol is realized via health management software. The algorithms are able to incorporate logic to process a wide range of data on an individual’s health status and recommend specific interventions matched to the etiology of an individual. The recommendations are different for each individual and change over time.

Ah, yes, “personalized” medicine and a “personalized” protocol. Muses Labs claim to use these factors to design a personalized treatment for MCI due to early stage Alzheimers:

Based on the recognized causes of cognitive decline, the MEND Protocol collects individual patient biometric and behavioral data, including:

Genome

Bio-specimen data

Medical history

Demographics

Medications

Patient lifestyle

Cognitive ability

The MEND Personalized Treatment Plan is provided to both the physician and the patient, so they can review the results together. The physician prescribes the treatment plan as appropriate. Patients are periodically retested and the treatment plan is updated over time.

You know, this protocol smells of questionable science. My skeptical antennae start really twitching when I read things like “toxicity,” “inflammation,” and “mitochondrial damage.” It sounds very much to me like “autism biomed” coupled with an appeal to genomics and computer algorithms. They start twitching especially hard when I see images like these on a website:

Yes, its’ a scientist in a white lab coat apparently manipulating a DNA double helix with his hand, complete with a white light that makes it look as though he’s shooting energy from his fingers. OK, it’s not quite that blatant, but it’s close. Star Trek fans might remember a term frequently used to describe some of the scientific discussions that occurred on the show, namely “technobabble.” Basically, technobabble consists of impressive and scientific-sounding jargon that, when examined more carefully, turns out to be basically meaningless.

This next part of the description of the MEND protocol might not be technobabble, but it is pure woo babble. Its very name (metabolic enhancement for neurodegeneration, abbreviated MEND) tells me that. So does this next bit:

The analysis algorithm recommends both pharmacological and non-pharmacological components. For example, if synaptic reconstruction and maintenance is needed, then multiple biological mechanisms may require normalization, enhancement, or administration. Examples of these underlying biological mechanisms include: periodically activating autophagy, blocking prionic tau amplification, increasing beta-amyloid clearance, inhibiting beta-amyloid oligomerization, minimizing inflammation, normalizing neurotrophic factors, reducing ApoE Ɛ4- mediated signals, reducing stress, reducing tau phosphorylation, restoring cholinergic neuro- transmission, and reversing memory loss. Assessing the status of these biological mechanisms involves quantifying and observing hormonal balance, citicoline, C-reactive protein and other inflammation-related markers, diet, exercise, homocysteine, omega-3 acids, sleep, and so on. Interventions targeting specific biological mechanisms are then prioritized and prescribed to optimize key biological mechanisms. Medication doses are specified to an individual’s needs. Individuals are re-tested periodically and the protocol is updated as necessary.

What the hell does this even mean?

Whenever I see claims like this, my first instinct is to go to PubMed. At the very least, I expect to find a list of publications on the company website. So, before going to PubMed, I perused the Muses Labs website. All I could find was one publication. Before I get to that publication, though, let me just take a look at some things I found using the almighty Google search. I can’t help but note that all the articles I found using Google mentioned the very same single publication.

As you probably know, Alzheimer’s disease is a form of dementia, of cognitive decline, related to aging. It isn’t (yet) known what causes it. It’s known that Alzheimer’s disease is a chronic neurodegenerative disease. It’s progressive and relentless and the cause of up to 70% of cases of age-related dementia. The cause of the disease is not well understood at all. It is known that Alzheimer’s patients tend to have amyloid plaques (amyloid is a protein) and neurofibrillary tangles in the brain. Currently there are no treatments that stop or reverse its progression, although some can temporarily reverse its symptoms. It’s a horrible, horrible disease, one that I can’t help but fear as I get older. When I have a lapse in memory, I have a tendency to joke about “early onset Alzheimer’s,” but it’s no joke at all. Alzheimer’s dementia is just about the worst fate I can imagine.

Muses Labs itself touts its approach thusly:

The approach we’re employing relies upon advanced software and big-data analytics, and incorporates decades of medical research. Muses Labs offers a service that utilizes the Internet and information technology innovations to make the Protocol practical and accessible to individuals with cognitive decline around the world.

Elsewhere, the company is described thusly:

The company says this approach to Alzheimer’s disease (AD) is based on the molecular biology of the brain and the bodily systems that support it. Decades of scientific research from around the globe are brought together and incorporated into MEND. Muses Labs combines medical expertise with software algorithms. Its algorithms figure out the optimal personalized therapy for an individual, and enables their physician to prescribe the therapy. Muses Labs software then motivates an individual’s adherence to the therapy it recommends.

All of this sounds all very nice and impressive, and there are indeed legitimate scientists on the Muses Labs editorial board, although there is also Dr. Mikhail Kogan, who just so happens to be the Medical Director and the Integrative Medicine Fellowship Director at the George Washington Center for Integrative Medicine, Washington DC. Not surprisingly, he also does geriatrics and embraces functional medicine. Come to think of it, this whole Muses Lab approach reeks of functional medicine, which I like to characterize as “making it up as you go along,” because of its reliance on lots of lab tests whose interpretation is questionable. In this case, we appear to be seeing functional medicine expanding into genomics.

Still, as many red flags as I see in the press releases and Muses Labs literature, it is always possible that the company is on to something. It’s not incorrect when it says that Alzheimer’s disease is very complicated, nor is it incorrect in its assessments of the current “state of the art” that single agent therepeutics have largely failed to reverse cognitive decline. However, it does not follow from that that the MEND protocol works. We’ve been using systems biology approaches to try to develop better treatments for various diseases for at least a decade now, and, in cancer at least, the results have been mixed. There was a lot of hype and hope at first, but it wasn’t long before that hype and hope ran straight into the wall of the implacable biology of the disease. So what’s the evidence for the MENDS protocol?

So let’s take a look at the publication that Muses Labs touts as evidence that its protocol is so promising as a treatment for early Alzheimer’s disease? Given that it’s the only study. It’s also a single-author paper, which is pretty unusual for any sort of case series or clinical trial. I know nothing about the author, Dale E. Bredesen, other than that he is affiliated with the Buck Institute for Research on Aging and UCLA’s Mary S. Easton Center for Alzheimer's Disease Research. It’s obviously a pilot study; in fact, it’s a small case series of ten patients treated with the MEND protocol.

This case series was immensely unsatisfying to read. It’s open access; so you can read it for yourself if you don’t believe me. I wanted to know more. I wanted to know just what the heck the MENDS protocol entailed. Unlike most papers reporting the results of case series or clinical trials that I read, this paper was very thin on the details. For example, this table describes it (click to embiggen):

The MEND™ protocol: Sure looks impressive and science-y, but it it either?

Patient #1 is a 67 year old woman with two years of progressive memory loss whose mother had developed progressive memory loss at roughly the same age, become demented, and ended up in a nursing home, not dying until she was in her early 80s. This was the regimen she was placed on:

As noted above, and following an extended discussion of the components of the therapeutic program, the patient began on some but not all of the system: (1) she eliminated all simple carbohydrates, leading to a weight loss of 20 pounds; (2) she eliminated gluten and processed food from her diet, and increased vegetables, fruits, and non-farmed fish; (3) in order to reduce stress, she began yoga, and ultimately became a yoga instructor; (4) as a second measure to reduce the stress of her job, she began to meditate for 20 minutes twice per day; [5] she took melatonin 0.5mg po qhs; (6) she increased her sleep from 4-5 hours per night to 7-8 hours per night; (7) she took methylcobalamin 1mg each day; (8) she took vitamin D3 2000IU each day; (9) she took fish oil 2000mg each day; (10) she took CoQ10 200mg each day; (11) she optimized her oral hygiene using an electric flosser and electric toothbrush; (12) following discussion with her primary care provider, she reinstated HRT (hormone replacement therapy) that had been discontinued following the WHI report in 2002; (13) she fasted for a minimum of 12 hours between dinner and breakfast, and for a minimum of three hours between dinner and bedtime; (14) she exercised for a minimum of 30 minutes, 4-6 days per week.

How we get from “systems biology” to yoga, exercise, weight loss, enough sleep, and a better diet is unclear. You don’t really need systems biology to suggest that these interventions will at least improve health and might slow cognitive decline. As for going “gluten-free”? On what rationale was that intervention based? I have the same questions regarding fasting and the vitamins. Basically, reading the relatively vague description of the MEND protocol provided here, I see nothing that requires all that fancy systems biology and those computer algorithms touted by Muses Labs. How “data-drive” and “big data” do you have to be to come up with this protocol?

Another failing of this writeup should be obvious to anyone who routinely reads (and especially to anyone who participates in) clinical trials. What were the objective outcomes? Even in a case series, there are usually some objective outcomes examined. For example, did they do various tests of cognitive function before and after, in order to determine if there was any objective improvement. How was the diagnosis of cognitive decline nailed down. Of the three (out of ten) patients described, patient #2 is the only one whose workup for Alzheimer’s disease was described in anything resembling in depth, and there is no report of any followup tests, just the patient and wife’s reports of his improvement. Basically, nine of ten patients reportedly demonstrated “objective or subjective” improvement, and six were able to go back to work. That’s nice, but where are the results of the full dementia evaluations, complete with standardized cognitive assessment examinations before and after the MEND protocol intervention? This case series really needs some meat on its bones before it will persuade me that there might be anything to this protocol. As it is, it sounds like one of any number of studies and case series published in CAM journals: Long on description, short on concrete reporting and controls.

As a pilot study, this sounds on its surface mildly promising, although it is really hard to tell given the lack of description of anything resembling something a clinical scientist would want to know to judge if further study is needed. Maybe it is. Maybe it isn’t. Another disturbing thing about this paper is that there is no mention of institutional review board approval, making me wonder if this was IRB-approved. Even a retrospective case series needs IRB approval, at least before publication, and this doesn’t seem to have it. Searches of Clincaltrials.gov failed to find registered clinical trials of the MEND protocol.

Maybe this protocol is worthy of further study. Maybe it’s not. I can’t tell for sure if it is based just on this paper and Muses Labs hype, both of which have enough red flags in them to make me think that the MEND protocol is nothing more than functional medicine on steroids. Whatever the case, however, I can be convinced, but not by this thin gruel. If Muses Labs and, presumably, GWCIM, are ever going to find out whether its protocol works to halt or reverse early cognitive decline in age-related dementia caused by Alzheimer’s disease, they should stop putting the cart before the horse and treating patients with an unproven protocol outside of the context of an IRB-approved clinical trial protocol. They should do the hard work it takes, get a protocol IRB-approved, and do the clinical trial before offering the MEND protocol to just anyone off the street suffering from early Alzheimer’s. That’s how you find out if a new protocol works. The MEND protocol might not be quackademic medicine, but how it’s being sold sure feels like it.

Oh, and try not to fetishize computer algorithms and systems biology so much. Nothing in the MEND protocol that I can see depends on either.

oracknows Fri, 06/17/2016 - 01:30

Tags

Clinical trials

George Washington Center for Integrative Medicine

alzheimer's disease

clinical trial

Dale Bredesen

George Washington University

http://www.buckinstitute.org/buck-news/Memory-loss-associated-with-Alzh…

Categories

Brain and Behavior

"This agreement allows individuals with pre- and early-symptomatic cognitive decline..."

Someone educate me. What is "pre-symptomatic cognitive decline?" Is that not something that, by definition, is not diagnosable?

The kindest way to describe it is experimental, even though it seems to be offered to anyone without a clinical trial.

Has the IRB weighed in on this? It sounds highly ... irregular.

a data driven, technology enabled, personalized methodology

One, I don't think "data driven" means what they think it means.
Two, a "personalized methodology" involves lots of N=1 cases. How do they get any kind of statistical power to determine whether the methodology works better than a control or placebo? I'll grant that it makes it impossible to disprove their hypothesis, but in medicine the burden of proof is (or should be) on the researcher(s) investigating a prospective new treatment.

Someone educate me. What is “pre-symptomatic cognitive decline?” Is that not something that, by definition, is not diagnosable?

Good catch. I didn't notice that. :-)

Looks like I picked the wrong week to quit wishing violence on quacks.

Pre-symptomatic cognitive decline could be detected by neuropsych testing, I guess. As long as the person does not complain of memory problems, they have no symptoms, by definition. Perhaps what they meant to say is "mild cognitive impairment," which is worse than normal age memory loss, but not full blown dementia. It is all part of a spectrum.

Well, the case study mentioned, the patient begins this protocol at age 67 and doesn't follow all the dictates in the program. So if the patient doesn't comply with the full program, how can we evaluate it?

But what I don't see is, how did the patient's course compare to the course of similar patients with Alzheimers? Yeah, she reported some cognative improvements over a couple of months but how do we know that's not the placebo effect? Alzheimers develops over a long period of time; where will she be in three more years and where is she now?

And were they on Aricept or Namenda during this trial?

God forbid this patient should eat a farmed fish.

Oh man that guy!! Saw Bredesen give a talk at a conference one time and the level of bizarre/crazy was strong with that one. He really came across more as a snake oil salesman than a scientist with his mysterious 20-step protocol or whatever it was.

Orac, this post is - in my humble opinion - wanting in its level of insolence. Or should I say that this MEND protocol seems to me to be deserving of a heapin' helpin' of it.

The whole thing seems to be a word salad. How does one determine if synaptic reconstruction and maintenance is needed? How does one then reconstruct a synapse? And how might biological mechanisms be administered? How does yoga block prionic tau amplification - or is it the veggies that do that? Maybe yoga is more involved in inhibiting beta-amyloid oligomerization? And this is being made available to real patients on the basis of 10 case studies which don't even include objective tests of cognitive function.

What a crock.

It's late, I'm tired and maybe I have my cranky pants on, but "the MEND protocol might not be quackademic medicine, but how it's being sold sure feels like it" seems too polite.

I'm not a neurologist or expert on Alzheimer's, and, unlike the case with vaccines, I haven't studied the issue to be as confident discussing it as I am discussing vaccines. So I toned it down a bit, in case I was in error about anything. Remember, a man's got to know his limitations:

I also didn't know that Bredesen was so full of woo, but I should have suspected it and spent some time Googling his name and reading some of his stuff. Another thing I had wanted to look into was the journal, but it had an impact factor of over 6, which makes it seem unlikely to be a truly woo journal.

Unfortunately, I am all too aware of Alzheimer's woo courtesy of PRN.fm.

Actually, the head honcho's woo is remarkably similar with a few differences:
more exercise ( an hour a day), no fish ( truly vegan), no HRT ( the demon's brew), loads of supplements, some targeting the brain ( like NAC) and powdered fruit and vegetables ( all conveniently sold at the website's store).

About the 'pre-symptomatic decline':
this woo holds that aging begins at age 27- it's early old age or suchlike. He gets people to label normal everyday forgetting ( I studied this stuff- believe it or not) as precursors to dementia. He usually tells and re-tells a story about a wealthy friend who didn't follow his advice and who keeps asking the same questions over and over; in addition, he has a testimony from a supposed professor of art history who has 'advanced AD' and whom he 'cured'.

And preventive woo is also out there. Same products, same protocol.

Unfortunately as well, my friend just had to fly to Ireland because her sister, not at all aged, developed AD - seemingly mild- but died of pneumonia within 6 months.

In other news...
Dan Olmsted has responded to me ( at the most appropriately named, " A particularly odious antivaccine 'warrior'... post ). He doesn't like experts it seems.

OT but it's Friday and getting later all the time, there are more than 10 comments and I have to leave soon because of an appointment...( is that enough?) so I ask whether braggadocio from an accomplished woo-meister is EVER truly OT at RI?
I would guess NOT.

Orac's non-fanboi, Mikey, is announcing that his new book is #1 at Amazon/ Science and Math. There will be a follow-up about pesticides. I can hardly wait.

The paper from Muses Labs notes:

I am grateful for support from the NIH (AG16570, AG034427 and AG036975)

He received Federal funding (not to mention the affiliation with UCLA), which therefore means the study is covered by the Common Rule and requires IRB review and approval. No mention is made in the paper of any ethical review.

What's worse, cognitively impaired individuals are considered vulnerable populations. 45 CFR 46 requires researchers and IRBs to include additional protections for the subjects.

"reducing ApoE Ɛ4- mediated signals"

How on Earth do you do that without installing profound dyslipidemia? It is theoretically possible (ApoE Ɛ4 polymorphism is associated with AD without dyslipidemia, so it's not like an ApoE loss of function), but I've never seen anything like it. Heck, I've never seen a researcher actually knowing what was in that polymorphism that did not prevent metabolic function but created the early-AD phenotype.

Bredesen has a new paper out. There's a link for it in this article. He's saying that he now has brain scans to 'prove' his protocol works. I haven't looked at the paper yet. I'm not sure I will - because it doesn't matter. His experiments have no controls as far as I can tell. It's incredibly bad science.
It's time for institutions like UCLA, the Cleveland Clinic, Johns Hopkins, George Washington - and too many others to name - to stop enabling this bad science. I find it difficult to believe that without a UCLA credential, Bredesen would have been able to publish this mess in anything other than a pay-to-play journal. But I'm a chemist and not all that familiar with the way medical publishing works - I could very well be wrong.
To me, this protocol is no different than what naturopaths do - throw supplements and diets at a problem willy nilly and take credit when the patient gets 'better.' And use terms like 'holistic' and 'combination therapy' and 'systematic' to try and make it sound more palatable and scientific.

Here's the link: https://www.sciencedaily.com/releases/2016/06/160616071933.htm

Heh. My timing's bad. The press release is yesterday, and I might have seen it. But unfortunately I didn't.

This putative trial has gotten a lot of publicity, entirely out of proportion to its merits.

Here's the Buck Institute press release:

Here's the UCLA press release:

http://newsroom.ucla.edu/releases/memory-loss-associated-with-alzheimer…

I would not call this a trial. Of the 10 subjects, each got a different set of putative therapies. The therapies sound like something you'd get at Whole Foods: gluten-free diet, probiotics, grass-fed beef, organic chicken, fish oil, CoQ10, yoga, music, meditation, fasting, etc. At best, I'd call this a study, and not one that should be taken very seriously. It's based on a dubious notion -- that monotherapies have failed, so we should try a whole bunch of therapies at once. There's no control group, the researcher seems to have evaluated the subjects' responses to treatment qualitatively in 7 cases, and the conclusions go far beyond any reasonable interpretation of these meager results.

Isn't this software considered a medical device? Medical devices are regulated by the FDA, so if this is a medical device there should be a filing for it.

this woo holds that aging begins at age 27

The idea isn't completely out of left field. There is a general consensus that most mathematicians do their best work before the age of 30. Einstein, for example, was 26 when he published the paper for which he was later awarded the Nobel Prize, but went down a number of blind alleys (e.g., unified field theories and "God does not play dice") starting in the mid-1930s. It's also well known that adults find it much harder than children to learn another language, though this is more of a a steady decline in that ability (e.g., one of the reasons Navajo code talkers were used in World War II is that the language is nearly impossible for somebody starting after the age of two to learn).

Of course, as is usual with woo that has a small element of truth to it, it is likely that this guy takes it much too far.

"The MEND Protocol is a data driven, technology enabled, personalized methodology to correctly identify and simultaneously treat the dozens of pathology drivers of age-related cognitive decline."

So much technobabble right out of the gate. Brutal.

@Debra M.

Looks like another bit of research for which Bredesen and his team did not report IRB approval.

I haven't yet read the whole paper in depth, but did look over patient 1. It's reported that:

During his 10 months on the MEND protocol, he interrupted his otherwise good compliance once, and this was associated with an episode of memory loss, in which he failed to remember that he had left his car in the driveway while he was working in his house.

Bredesen explains that the episode of memory loss is because Pt 1 stopped the protocol. It is equally possible that Pt 1 stopped the protocol due to AD. IIRC, AD has alternating episodes of memory loss and lucidity, with poor cognitive function becoming an increasingly frequent event.

With no controls, and no methods described, the paper is useless with regard to drawing any conclusions on efficacy.

Todd W@22:

a.k.a. Always plame the patient, never the treatment. Where have we heard that before?

Let me first say I love this blog.

I think this, however, is a case of you throwing the baby out with bathwater. I don't see any connection of Dale Bredesen, or any of his co-authors, to Muses Labs at all…

Dr. Bredesen is very reputable researcher, who beyond doing these case studies finds time to publish many other pretty interesting papers, like this one about APOE: "http://www.jneurosci.org/content/36/3/685.short".

Also, Mark Thorson, in the comments you claim that "it's based on a dubious notion — that monotherapies have failed, so we should try a whole bunch of therapies at once." Where is your evidence that this is a dubious notion?

I actually believe combination therapies are incredibly underexplored… There are obvious reasons why they are underfunded in industry, such as IP issues, and an inability to quickly obtain data necessary for approvals. They can also be challenging to execute, especially with protocols as ambitious as this one. But even very senior execs in industry believe they could hold a lot of promise.

I haven’t had time to read the latest paper in detail either, but it definitely appears to beef up the objective and quantifiable measures. I realize it is not a RCT, but this is clearly the direction the authors would like to go, as they write “The results also support the need for a large-scale personalized clinical trial using this protocol.” It is still preliminary data, but promising, and especially given it’s in such a serious disease like Alz, and one that is littered with so many high-profile failures of monotherapies. Let’s not let perfect be the enemy of the good!

Dr. Bredesen is very reputable researcher

Irrelevant. Linus Pauling, Brian Josephson, and Sallie Baliunas[1] (to name three examples off the top of my head) were once well-respected researchers, too. That was before they involved themselves in various pseudoscientific pursuits: Vitamin C as cure-all, extreme racism, and climate science denialism, respectively.

I have no idea whether Bredesen published good science in his younger days--I'm not qualified to evaluate it myself. But he's clearly gotten into some disreputable stuff lately. If he really had anything promising, he would be working toward setting up a full clinical trial with enough patients enrolled to have some statistical power for determining whether the protocol(s) is(are) more effective than placebos. And he would make sure that he had IRB approval for this clinical trial. He wouldn't be mucking about with case studies that don't have IRB approval. He should know better, else he would not have obtained or kept a position at a reputable school like UCLA.

[1] I recall that Baliunas gave a colloquium in my Ph.D. department when I was a young grad student. Her research focus was on solar physics. This was before she started collaborating with Willie Soon to produce a series of easily refuted papers on the Sun's influence on the Earth's climate.

Bobby Brooke #24

I think this, however, is a case of you throwing the baby out with bathwater. I don’t see any connection of Dale Bredesen, or any of his co-authors, to Muses Labs at all…

I won't comment on the rest of your comment as I want to read the paper first, but I am wondering if you actually looked to see if there was a connection between Dale Bredesen and Muses Labs, because it took me less than a minute to find this page, which clearly indicates his extremely strong connection to Muses Labs:
https://webcache.googleusercontent.com/search?q=cache:deRFQ6OfDYAJ:http…

Research Triangle Park, NC – December 5, 2013 – Dale Bredesen, MD, co-founder of North Carolina-based Muses Labs, Inc.

Dr. Bredesen is the Chief Medical Officer for Muses Labs...

It seems he stepped down in 2015, but that was after this paper was released
http://www.prnewswire.com/news-releases/dr-dale-bredesen-announces-term…

@Travis

One notes that in the original study solo-authored by Bredesen, which Orac linked to, he declares he has no competing interests. However, the MEND Protocol was developed by him and Muses Labs, so he conceivably stood to make money if the research supported his claims. A quick scan of the paper found no mention of Muses Labs or Dr. Bredesen's connection to it.

@Todd W,
After writing my comment I thought to check, which I should have done earlier, and noticed the same.

Looking at the journal's CoI statement, it seems like his connection to Muses Labs should have been made clear.

Financial relationships (such as employment, consultancies, stock ownership, honoraria, paid expert testimony) as well as personal relationships and academic competition must be declared. The authors declare conflicts of interests and sources of financial support as acknowledgment.

http://www.impactaging.com/forAuthors.html

Wouldn't getting the recommended amount of sleep generally help your cognition? (Patient #1 went from 4-5 hours of sleep to 7-8.)
And I know my dentist is in love with electric toothbrushes (and water picks), but even he wouldn't try to claim it will prevent dementia. How would that even work?

@Travis #26
I did look, but only at their website, so many thanks for showing that he may have been involved at one point, but that he terminated his relationship with them. Beyond that, the press release writes that he "severed all professional and scientific relations with Muses, including all professional and scientific relations with Muses, including consulting, trial participant review, and any interpretation of Muses information." This does not look amicable in any way, so he has clearly distanced himself from this group.
The press release goes on to describe him setting up his own company, MPI Cognition.

@Todd #27
I don’t believe what you write that “the MEND Protocol was developed by him and Muses Labs.” As you mention also, Dr. Bredesen is listed as the sole author on the 2014 paper. He doesn’t list conflicts of interest, but he does list in the acknowledgements his financial support from groups like UCLA, Buck Institute, Alzheimer’s Association, and private individuals. If I had to guess, I’d say he probably debated whether to list companies like that one, and MPI Cognition on this recent paper, but determined they didn’t meet the threshold. They most likely didn’t provide any financial support related to the research, and they’re so probably so early-stage that they haven’t provided him any consulting fees whatsoever. So even though he may have a title, it could still be somewhat debatable as to whether or not he really needs to list them. In any case, especially with this MPI Cognition company, it looks less like he’s trying to profit from it, and more like he’s trying to setup the infrastructure to recruit patients, run all of these assays necessary, and coordinate logistics to enable a large RCT to get more definitive proof that this regimen works.

@Eric #25
The paper on a surprising new molecular mechanism of ApoE4 (the single leading genetic risk factor for Alz) was published in January 2016, so hardly from “his younger days”. More on it is here: https://www.sciencedaily.com/releases/2016/01/160128155753.htm

@Orac #10 & #17
I hope you’ll read the latest paper and continue to revise and add relevant details…

@JustaTech #30
Yes, good oral hygiene for Alz sounds goofy to me, too, but lo and behold, there’s fairly decent evidence to support it: “http://www.medicalnewstoday.com/articles/264164.php”. It’s also an example of something that’s entirely without risk and could reasonably help, so why wouldn’t you do it? Where this gets more even more interesting is when regimens/protocols like this become the new norm, and all patients adhere to them, and then you can combine them with leading AD investigational treatments (i.e. even some of those compounds that failed when developed as monotherapies in the past).

Orac #10 - point taken. My cranky pants were definitely on (they're so comfy) - I had spent a good part of last evening reading _all_ the comments over at the SBM post on... I don't want to derail this thread by mentioning it... rhymes with 'fun patrol'.
And it seems you're damned if you do and damned if you don't - I complaint that you're too reserved, someone else complains that you're throwing the baby out with the bath water.

As a Learned Sage told me this afternoon on a different forum:

"All that data sounds really good if you did not develop (condition X) but if you were one of the one in two hundred twenty seven who did develop (condition X) then you would be really happy about subjecting everyone in your age group to (invasive exploratory procedure A) despite the weight of expert opinion against such screening."

The word 'smug' was thrown around a bit, not by me, and I am pretty sure that I did not manage to influence a single opinion.

@ Denice

Orac’s non-fanboi, is announcing that his new book is #1 at Amazon/ Science and Math.

Gah, it's now number 3, so I guess that was right at some point. And at some point, it was a number 2, but everything HWSNBN does is a number 2.

OTOH, Randall Monroe's excellent "What if" is number 8. That's something.

OK, I should stop posting off-topic now.

@ Eric Lund

Right. There's some stuff in cognitive about prime time for mathematicians, physicists et al and memory / learning.
BUT
I think that the hoary old woo-meister
is talking more about the hotness factor or suchlike for women. ( who according to his calculations are quite over and done early UNLESS THEY follow his protocols to the letter of the law)

@ Helianthus:

When I last looked his barrel of tripe ... I mean *book* was at one with Mukherjee trailing.

I'm a spy in the house of woo**

For the past two and a half months I've been suffering with a relatively minor but irksome injury- originally, I hurt myself whilst reading a menu in Portuguese when my sandal caught upon a broken paving stone during the financial crisis a few days after a flu vaccine.
I have since re-injured it a few times
HOWEVER this time it's taking longer and I began to lose patience. using anti-inflammatories, ice and mild exercise have all helped but I am not myself yet.

One of my gentlemen suggested various woo-fraught activities including acupuncture - I recoiled and mentioned toothpicks immediately-
HOWEVER there were hidden incentives in this altie programming schtick- it was Chinese therapy- not just acupuncture and SOMEONE else was paying***

So armed with cash and a cavalier attitude, I embarked on a suburban journey to the offices of a Dr Hsu ( not her real name) who has been doing this for 35 years in both a city and suburban locale- posh and semi-posh, respectively.

I filled out a long laundry list of possible complaints ( I actually have very few) and met the practitioner who was abrupt but cautiously friendly. I was told my tongue betrayed my 'low energy' and that I might need supplements ( which weren't mentioned later at all surprisingly). She started to press upon various points around my jaw and ears as well as down my leg where the problem was: her bony fingers poked sensitive spots - I suppose places where the Qi is blocked or suchlike. She carefully applied the disposable needles, unwrapping each one.

A few of the spots seemed quite sensitive but one near my knee felt really differently as she pressed and poked at it doggedly for a while. Then she applied a heat lamp aimed at the OTHER leg and left me to listen to Chinese classical music for 30 minutes.

My next 2 visits included more probing, needles and last but not least- CUPPING!- which was the be-all and end-all of woo. She placed more than a dozen mini glass fish bowl-like cups down my side and leg - some of which were rather discomforting and left marks ( fortunately, not the ones on my thigh which can be easily seen). I suppose it extracted the stagnant Qi or Evil as each one popped when she removed it.

All in all, I do feel better but first of all 2 weeks have past, I continued taking meds, doing exercises and drinking wine. I must admit that she did something when she pressed and fixated upon that one particular point near my knee on the first visit. My best guess is that she did something like the tui na practtioners- i.e. massage therapy / physiotherapy-like- and that all the rest was merely window-dressing. BUT I do think that she believes in it all.

** oh why not?
*** I never pay for woo in any way, shape or form

I'd really like to see the insides of these "algorithms". Something tells me they're basically just choosing a bunch of treatments in their database based on RNG and displaying them on screen.

Garou, several "deep learning" systems have appeared recently (Google's TensorFlow, Berkeley's Caffe, IBM's SystemML, and a host of others). Nearly all of these systems are freely available. I predict all sorts of meaningless misapplications of these systems , far more than from people who understand their use and limitations.

@ # 24 "Dr. Bredesen is very reputable researcher..."

Apart from the fantasy press releases, which in UCLA's case the central administration should look at in a misconduct inquiry, I would think that Dr Bredesen, or others close to, will have a small-cap start-up company somewhere not far from an IPO, selling personalised treatment programmes.

Conspicuously bullshit packaging of diet and exercise lifestyle improvements, may of which anybody who hopes to be in their right mind at 80 should adopt.

I think this is quite interesting from a medical/scientific perspective, but less so and more challenging from a business perspective. It obviously is not the traditional patented monotherapy pill-in-a-bottle approach.

In a perfect world / more efficient market, more rigorous programs like this might be really well rewarded, but there's so much overhyped research and supplements out there (plenty of good stuff, too, though) competing for people's attention, I would think it'd be tough.

In any case, maybe I'm naive, but the latest data (June 2016) look pretty interesting: "http://www.impactaging.com/papers/v8/n6/full/100981.html".

I saw that after I wrote my post (awesome timing, no, to have written a post the very same day that a press release touting a followup study came out?), and I do plan on writing a followup, perhaps for Tuesday or Wednesday. (Monday's post is already written.) It's not nearly as interesting as you think.

The more I read this stuff the more I am convinced that it concerns BUSINESS plans not research.

"You know, this protocol smells of questionable science. My skeptical antennae start really twitching when I read things like “toxicity,” “inflammation,” and “mitochondrial damage.”

Orac, to be fair those are indeed mecanism that are believed to be implicated in Alzheimer's dementia, especially mitochondrial damage and inflammation. "Toxicity" is a bit vague but i could refer to "neurotoxicity" caused by amyloid-beta and tau oligomerization in brain. What is mostly quacky here is the next part :

"Examples of these underlying biological mechanisms include: periodically activating autophagy, blocking prionic tau amplification, increasing beta-amyloid clearance, inhibiting beta-amyloid oligomerization, .... blablabla...."

-> Which is mostly a mixing of all the keywords associated with Alzheimer on pubmed.

To my mind the biggest red lights are a) the papers have not disclosed the exact treatment regimens, and b) MEND is a commercial "thing" before it's even been subjected to proper (RCT) testing.

Something else about that complicated treatment regimen:

The complexity of it could potentially be used as a set-up for "the failure of treatment was not the fault of the treatment regimen, it was the fault of the patient for failing to follow it exactly."

We have a phrase around here for that, that I can't remember at the moment (eeek!, early-onset AD;-) but also involves the element of "the patient didn't believe hard enough!" I suppose for patients whose brains are being eaten by AD, it's easy to "not believe hard enough."

My "alt med warning light" is blinking yellow.

-----

Denise @ 37:

I also had an opportunity to guinea-pig alt med on myself recently. A horrid cold with a vicious sore throat that would not go away. After a night of "sore throat was so bad I couldn't sleep," I thought "research opportunity to test some quacky stuff" since in my view of things, misery is more bearable when it's a chance to produce or collect information.

Long story short, I got some "Emergen-C" fizzy vitamin C drink powder (1,000 mg. vitamin C and 22 mg. zinc per dose), a particularly egregious-looking example of supplement woo. I gargled one packet during the day, one before bed. Woke up the next day with sore throat nearly gone. Gargled two more packets of the stuff that day, and the sore throat was completely gone the day after that. "WTF?!"

To my mind that was too pre/post for coincidence, and too clear-cut for placebo. The plural of anecdote is hypotheses; someone ought to run a controlled test to see if there's anything real to this. Then if it actually works, it should be adopted into evidence-based medicine quickly enough that alt-med can't get traction to claim credit for it.

It sounds to me like MEND is being healthy. Diet, exercise, that sort of thing. Adding FDA-approved drugs if symptoms. What's new in this?

I saw an article about MEND for the first time in the DailyKOS today. This really undermines my confidence in that newsletter.

Rather than knock down alternate methods, emperical evidence can be good enough when the results are achieved. The only problem with mono therapies are that they don't always work and there's a lot to be gained financially to convince a large population of people that it's all backed by science. There's emperical evidence that too many people get side effects worse than the treatment (and never cured) by allopathic methods, regardless of science. When you start nit picking for scientific studies things become muddled without seeing the results best given by the patients themselves. It's not all quackery. It's only quackery to those who don't bother to explore that maybe what they believe to be the best science isn't always the best for human outcomes. Furthermore, I say just follow the money trail, which isn't always a bad thing unless someone stands to lose something valueable from another's gain. Not having scientific evidence vs patient results is not one of them.

I very read plenty of publiahed studies on diabetics and found them mostly lacking in their initial setups, basically nullify ingredients the whole thing. I decided to use foods, diet changes and watching results long term

.....and found it more effective than pill therapies. This used on family members disgruntled with the confusion and side effects of scientific studies.

Goldie: where does the money trail for all those supplements that are so wonderful lead to? And, as has been noted many times (even in this post!), dietary changes to control issues (T2 diabetes, high cholesterol, obesity), exercise, increased sleep are NOT alternative medicine; they are part of every good physician's care.

Followup post here:

http://scienceblogs.com/insolence/2016/06/24/the-mend-protocol-for-alzh…

Please move this comment thread over there. Thanks.

Want to find out what the "MEND protocol" is? Guess you have to buy the book..

"Dr. Bredesen’s book describing for a broad audience the interventions described in this paper, will be released by Penguin Random House in May 2017." (From http://www.buckinstitute.org/buck-news/reversal-memory-loss-ad).

It all sounds rather sketchy. Too bad. It is always hard to know what to make from what is essentially a case series, but it does sound like one or more of this group of interventions might of worked for some individuals. It is impossible to tell though from the way this thing was put together and all the unmentioned conflict of interests makes the whole thing sound very questionable.

Quackademia at the University of Toronto: Antivaccine pseudoscience taught by a homeopath is "not unbalanced"

oracknows — Tue, 07 Jul 2015 01:00:40 +0000

Quackademia at the University of Toronto: Antivaccine pseudoscience taught by a homeopath is "not unbalanced"

Aside from deconstructing the misinformation and pseudoscience of the antivaccine movement, another of the top three or so topics I routinely discuss here is the infiltration of pseudoscience into medicine. In particular, I've found and discussed more examples than I can possibly remember of what I like to call quackademic medicine, defined as the infiltration of quackery into academic medicine. This quackery mainly insinuates its way into medical schools and academic medical centers through the emerging specialty known as "integrative medicine," which used to be called "complementary and alternative medicine" (CAM). What "integrative medicine" involves is the integration of prescientific mystical beliefs about medicine rooted in vitalism and pseudoscientific quackery into science-based medicine (SBM). That's how we find modalities like reiki (faith healing that substitutes Eastern mystical beliefs for Christian beliefs) and traditional Chinese medicine (which is based on concepts very much like the "Western" idea of the four humors) in many prestigious academic medical centers, such as the Cleveland Clinic, University of Arizona, UCSF, and even the Memorial Sloan-Kettering Cancer Center. Meanwhile, medical schools like Georgetown and the University of Maryland (to name but a couple) rush to integrate quackery into their undergraduate medical curricula, while respectable professional societies like the American Society of Clinical Oncology feature "integrative medicine" sessions at their annual meetings. Years ago, I used to maintain a list that I called the Academic Woo Aggregator, but there was just so much quackademic medicine that I gave up updating it long ago.

When I noted that my very own alma mater, the University of Michigan, has a program in anthroposophic medicine, I despaired. I thought that that was as bad as it could get. Then I came across Jen Gunter's blog posts and news stories about quackery at the University of Toronto, specifically a course being taught by Beth Landau-Halpern, a homeopath.

Let that sink in a minute. There is a course in medicine, specifically alternative medicine, being taught by a homeopath, and, worse than that, it's featuring Joe Mercola interviewing Andrew Wakefield as a legitimate source of information on vaccines.

This particular homeopath happens to be the wife of Rick Halpern, the Dean of the University of Toronto, Scarborough Campus, which is the campus where the course was offered this spring. The course was called Alternative Health: Practice and Theory HLTD04H3-S Special Topics in Health, and it is loaded with quackery, as you can tell just from the course description:

Alternative medicine (i.e. the wide range of modalities other than conventional western biomedicine), has gained unprecedented popularity among patients, and a nearly unprecedented backlash from the scientific and conventional medicine communities of late. Dissatisfaction with the results and quality of care patients get from mainstream medicine, how well they are (or aren’t) listened to, the astronomical cost of such medicine, increased suspicion of pharmaceutical safety, a generalized belief that natural is better, and, in some instances, a preference for culturally traditional medicinal practices, are some of the many factors that drive patients to seek alternative health care. At the same time, the “scientification” and “technicalization” of medicine seems to be widely accepted and is employed to assert the perceived fundamental superiority of a biomedical approach to disease; to further the financial incentive of the pharmaceutical industry which has an enormous stake in the scientific, drug-based approach to health; and to disparage “alternative” approaches as quackery and fraud.

Yes, there are the same old complaints from alternative medicine practitioners, such as that medicine is arrogant and asserts its superiority due to science (as if being science-based were a bad thing!) and invokes a bit of the old "pharma shill" gambit as a reason why alternative medicine hasn't become more accepted. Then, there's some serious woo-speak that regular readers of this blog will have seen in various forms before but that one doesn't expect to find stated unironically in the course description of a class offered by a major university:

We will delve into a quantum physics’ understanding of disease and alternative medicine to provide a scientific hypothesis of how these modalities may work. Quantum physics is a branch of physics that understands the interrelationship between matter and energy. This science offers clear explanations as to why homeopathic remedies with seemingly no chemical trace of the original substance are able to resolve chronic diseases, why acupuncture can offer patients enough pain relief to undergo surgery without anesthesia, why meditation alone can, in some instances, reduce the size of cancerous tumors.

Yes, there's quantum quackery in that there course description! Need it be repeated that homeopathy is The One Quackery To Rule Them All, and that quantum "explanations" offered by homeopaths for homeopathy can "work" invoking "energy" are abuses of physics of the worst sort, as are other scientific concepts co-opted to serve the quackery that is homeopathy, such as nanoparticles. Don't believe me? Just check out Charlene Werner's explanation of "energy" to get an idea of how bad it can be (NOTE: this is NOT Beth Landau-Halpern):

I'm not saying that's what Landau-Halpern taught (that is, after all, not her), but it is the sort of nonsense you get when a homeopath invokes quantum mechanics, which is why, based on the syllabus, it wouldn't surprise me if that's the sort of thing Landau-Halpern taught. If that's not enough for you, you should try to check out Lionel Milgrom's epic quantum quackiness about homeopathy. But beware. If you're an honest-to-goodness physicist, reading Milgrom's stylings could melt your brain. If you're a skeptic, they'll evoke a combination of disgust and hilarity. It was so bad that physicists wrote to the university to complain.

It gets worse, though. The abuse of physics is nothing more than the standard quantum nonsense that quacks invoke the way shamans invoke magic and the gods. it's bad, but it doesn't directly degrade public health. (Indirectly is another matter.) One of the classes in the course, however, does just that. I'm referring to week 9, a class entitled Vaccination – the King of Controversy. First, before I show you the suggested reading, let me just say this. Vaccination is not controversial from a scientific standpoint. It's really not. The "controversy" over vaccinations is what I like to call a pseudodebate, where science denialists use misinformation, cherry picked studies, and bad reasoning to attack established science. This course does nothing but feed that pseudodebate among its student,s as though it were legitimate. Don't get me wrong. I don't object in concept to a course that looks at the antivaccine movement and its arguments, but such a course must be rooted in science and critical thinking, so that it helps students understand why antivaccine misinformation is not supported by science. Ditto quantum quackery. Instead, we get this:

Required Readings/ Viewings for this week:

VIDEO: Interview with Andrew Wakefield: http://articles.mercola.com/sites/articles/archive/2010/04/10/wakefield…

VIDEO: Shedding: https://www.youtube.com/watch?v=VKSeiAs_A4w (new addition to syllabus)

VIDEO: Vaccine's Safety A Crime Against Humanity, http://www.youtube.com/watch?v=9N3oHLe80O4

Dissolving Illusions, Disease, Vaccines, and the Forgotten History, pp vii-xvi, 445-479

Optional Reading:

Vaccination, Social Violence and Criminality; The Medical Assault on the American Brain, Harris Coulter – Ch. 7 (Medical Hubris and Its Consequences), Ch 3 (The Post-Encephalitic Syndrome)

ARTICLE: http://www.collective-evolution.com/2013/09/12/22-medical-studies-that-…

ARTICLE: http://www.collective-evolution.com/2014/12/03/mit-scientist-shows-what…

96 Research Papers Autism/ Vaccination. http://www.scribd.com/doc/220807175/86-Research-Papers-Supporting-the-V…

This Physician’s Assessment of Flu Vaccines in Pregnancy http://www.safeminds.org/blog/2014/09/24/physicians-assessment-flu-vacc…

Safeminds? Collective Evolution? Joe Mercola? Andrew Wakefield? These are not reliable sources on vaccines. They represent the underbelly of the antivaccine movement. Hell, why not include the antivaccine crank blog Age of Autism as a legitimate source while you're at it? Notice also how there isn't the "other side" of this "controversy" offered, as in information on vaccines from the CDC, vaccine scientists, and legitimate sources. It's all one-sided—the antivaccine side.

But wait, there's more! Week 10 is all about "detoxification" in the context of naturopathy: CAM Modality: Naturopathic Medicine: Nutritional Deprivation and Environmental Toxins and Their Impact on Health and Brain Function. Naturopathy, of course, is pure quackery, as is the "detoxification" recommended by naturopaths, who, by the way, also are all trained in homeopathy and most of whom still use it.

Now here's the incredible thing. Because of the complaints, the University of Toronto undertook a review of the course. According to the review, carried out by Vivek Goel, Vice-President, Research and Innovation, there wasn't a problem! Seriously, after examining the curriculum of the 2015 course and the student evaluations from the 2014 course, Goel concluded that there wasn't a problem! First off, he let Landau-Halpern off the hook for her antivaccine nonsense by noting that she changed the curriculum in 2015 in the wake of the Disneyland measles outbreak and had "voluntarily removed the section for which the greatest degree of concerns were subsequently raised."

Incredibly, Goel then concluded:

I did explore with her how she approached this topic in 2014 and how she would have done so if it had remained on the curriculum this year. She reports that she approaches this issue from a nuanced perspective and encourages students to think critically about vaccine effectiveness and safety.

The syllabus for the course contains a reading list for the immunization class which gives emphasis to materials s that primarily focus on risks for vaccines. The instructor reports that she provides these readings as the students have already seen the other side in previous courses. In class they are then able to have a discussion from all perspectives.

As a result, I do not find that the instructor’s approach in this class has been, or would have reasonably been perceived to be unbalanced, in the sense that it deviated from a presentation of material that, in context, would enable critical analysis, and inquiry. Thus, from an academic pedagogy perspective, I do not find that there has been sufficient deviation from the range of normal approaches to warrant concerns.

With a reading list like this, there's no way what was being taught in any way resembled critical thinking, particularly taking into account that Landau-Halpern is a homeopath. More than that, she's a homeopath who's been busted by investigative journalists. A CBC Marketplace investigation filmed her advising a young mother against vaccines and promoting homeopathic nosodes as an alternative. Nosodes, of course, are pure quackery. Not surprisingly, Landau-Halpern cried "entrapment! She also offers homeopathy to treat ADHD and CEASE therapy (based in homeopathy) to treat autism.

Shockingly, all Goel could come up with was this:

On review of the process it does not appear that there was adequate consideration or comment by the department and colleagues on the proposed course outline developed in 2013 for the Spring 2014 session, nor for the Spring 2015 session. While I do not find that the course is unbalanced, in the sense of the term used above, I do believe it could be strengthened by greater engagement of academic colleagues through such a review process. The Department Chair and Program Director will continue to work closely with the instructor through the balance of the term. If the course is to be offered again in the future it should be developed as a regular course and taken through the usual governance reviews.

Oddly enough, the Department of Anthropology is the department responsible for the Health Studies Program, under which this course fell. Clearly, the department utterly failed, and U of T administration is basically shrugging its shoulders over it. Goel sees nothing, hears nothing, knows nothing, just like Sgt. Schultz in Hogan's Heroes.

Unfortunately, this is not the only problem that U of T has had with quackademic medicine. U of T is, after all, the home of another homeopathy aficionado, namely Heather Boon, Dean of the Leslie Dan Faculty of Pharmacy and principal investigator of a clinical trial testing homeopathy for ADHD. The university has also hosted a quackfest known as the IN-CAM Symposium, where homeopathy, naturopathy, and chelation therapy featured prominently. This is consistent with its recent founding of a its new Centre for Integrative Medicine on—surprise! surprise!—the Scarborough Campus. This is a typical center dedicated to integrating quackery with medicine, in particular traditional Chinese medicine. When pseudoscience invades a campus that way, is it any surprise that a course taught by a homeopathy spouting antivaccine propaganda and quantum woo start popping up?

I feel sorry for my bud Scott Gavura and all the good pharmacists, nurses, and physicians who trained at U of T, because it's clear that the university has gone all in for quackademic medicine. What's next? Teaching young earth creationism in biology classes? Teaching astrology in astronomy class? If U of T doesn't care whether its course offerings are scientifically valid any more, why not really go all in for pseudoscience? After all, Beth Landau-Halpern's course is nothing more than the latest culmination of an infiltration of quackery that's been going on for years now. The administration might as well found a naturopathy school at this point.

ADDENDUM: Apparently Beth Landau-Halpern's class is gone and she is no longer on staff:

http://www.speakingupforscience.ca/news/2015/7/6/lecturer-who-taught-anti-vaxxer-propaganda-no-longer-at-u-of-t

Not much in the post in that link hopefully we'll learn more.

oracknows Mon, 07/06/2015 - 21:00

Categories

Environment

All the education you have under your name and yet you are still a moron.
William W Thompson just went to the Obama administration and applied and received f'Whistleblower status' in regards to Autism and the MMR.
Btw right after he was granted Whisteblower, Julie Gerberding just sold a ton of Merck stock for over 2 million dollars. Cashing out while she can I suppose.

oh and btw, these are his lawyers. Their specialty is Whistleblowers.
Hear that sound? That is the ship striking the iceberg.

http://www.morganverkamp.com/august-27-2014-press-release-statement-of-…

Here is an actual unbiased article that examines the 2 sides of the vaccine debate. The anti-vaxxers and the people such as yourself. Both groups completely unwilling to ever consider middle ground. I suggest you read it, as maybe you will actually learn something for once.

http://www.truth-out.org/opinion/item/29060-selective-outrage-and-publi…

I read it first yesterday night at Jen Gunther's blog. I have been working around Toronto a few years ago, and UToronto was then regarded as a landmark of excellence, so this story was resonating slightly personally.
I knew they already had "integrated" a naturopath cursus. But this story about an homeopath teaching the other side of vaccines triggered in me a massive WTF moment.
Coming from a place where insulin was first extracted and then used to save the life of a diabetic boy in the hospital next door, it's a really sad orientation.

A CBC Marketplace investigation filmed her advising a young mother against vaccines and promoting homeopathic nosodes as an alternative.

Oh, so it was her, to top it. I didn't know that.
And how the heck the university dean doesn't smell some massive conflict of interest, here?
I mean, it's one thing to teach about something you happen to be selling, but a whole course dedicated in dissing your competitors?

I have to be honest, I could not get through more than a couple minutes of that video - it was downright painful. Forget quantum physics, I don't think she even understands algebra.

Aaaand... she's gone.

http://www.speakingupforscience.ca/news/2015/7/6/lecturer-who-taught-an…

We will delve into a quantum physics’ understanding of disease and alternative medicine to provide a scientific hypothesis of how these modalities may work. ... This science offers clear explanations as to why homeopathic remedies with seemingly no chemical trace of the original substance are able to resolve chronic diseases, why acupuncture can offer patients enough pain relief to undergo surgery without anesthesia, why meditation alone can, in some instances, reduce the size of cancerous tumors.

I did my Masters and PhD at UofT in physics (particle physics) so have more than a passing knowledge of QM. It saddens me that UofT offers a course where such a statement can be made. Letters of concern shall be sent.

Aaaand… she’s gone.

That was quick.

Someone from higher up in the administration saw the potential reputational damage this might cause.

Aaaand… she’s gone.

I should have read the comments first.

This all sounded so familiar. Turns out a very similar thing happened just a stone's throw away at Queen's University earlier this year. For a while I wondered if it was the same person, but no it was not.

http://storify.com/iDuchaine/anti-vax-have-no-place-in-canada-s-univers…

William W Thompson just went to the Obama administration and applied and received f’Whistleblower status’

I am not sure this is the case. There is no record that this has happened.

What it has to do with teaching homeopathy at the University of Toronto I am struggling with.

Nothing. It has nothing to do with U of T. I suggest that "he who laughs last" choose a vaccine thread if he/she/it wants to spew that nonsense. If he persists on this post with off-topic comments I will simply delete them.

@ Bob

I don’t think she even understands algebra

There is some part in the video where she simplifies E=m.c2 into E=c2, because the mass of the whole universe is negligible.
The most beautiful* division by zero I ever saw.

* in the artistic sense. In the arithmetic sense, it's awful.

I just explained her simplification of E=mc^2 into E=c^2 to a colleague. We had a good laugh (tinged with sadness that this level of crap could be taught in a University Course). I used to have 1st year students do this on lab reports/assignments (when stuck on a problem) in the hope that I'd not notice.

Whatever the case may be, someone's corn flakes definitely got pissed in this morning.

Quantum physics is a branch of physics that understands the interrelationship between matter and energy. This science offers clear explanations as to why homeopathic remedies with seemingly no chemical trace of the original substance are able to resolve chronic diseases, why acupuncture can offer patients enough pain relief to undergo surgery without anesthesia, why meditation alone can, in some instances, reduce the size of cancerous tumors.

As Stewart (above) notes, the University of Toronto has a reputable physics department, and even the undergraduate students in that program (let alone the faculty) could tell you that the above quotation is unadulterated malarkey. Quantum physics deals with the microscopic behavior of matter. It can tell you in precise mathematical detail why homeopathy doesn't work (but it's overkill for that purpose; you get essentially the same answer if you use high school chemistry). Acupuncture needles are big enough that any effects they might have should be explainable with classical physics, without invoking quantum effects (at that scale quantum physics reduces to classical physics). The last claim about meditation is meaningless, since we don't have an adequate description of the physics of meditation.

Oh, and she (or maybe the woman in the video, which I haven't watched) is invoking E = mc^2? That's special relativity, not quantum physics. TV Tropes has an entire page devoted to that sort of thing.

"While I do not find that the course is unbalanced, in the sense of the term used above, I do believe it could be strengthened by greater engagement of academic colleagues through such a review process... If the course is to be offered again in the future it should be developed as a regular course and taken through the usual governance reviews."

This is academic-speak for "We've got to cover our asses better the next time we offer crap taught by relatives of influential administrators."

#3 @he who laughs last

So what does your middle ground look like?

Because there is something a bit binary about it. Either you vaccinate enough people to either eradicate a disease (which we can do with significant effort and expense) or keep it mostly at bay or you do not. Because lets work really hard to make sure the grandkids don't even need some of the vaccinations anymore because it is gone makes more sense to me than lets work really hard to make sure the disease will always be with us because we will not ever do anything to make sure enough people are vaccinated against anything ever again.

Vaccinating 50% of the people 50% of the time (the absolute middle) just ensures the diseases can never be eliminated and no amount of sanitation or vitamin pills is going to do what the vaccine will.

Or do you pick 50% of the vaccines to keep mandating and just hope enough people volunteer for the rest that you never come across someone contagious with the other things?

Do you include the harms from the diseases in determining where "middle" is?

Do you just chuck all the science because we don't actually spend the time and money it would take to fix the system, and do you acknowledge there can be bad science on both sides of the debate or is most pro-vaccine science bad and most anti-vaxx science is good no matter how many times it is found to be problematic? Or just put it all in a blender and hope the sludge is about 50% right?

Oops, sorry I asked questions, I just find the middle ground argument annoying. I will stay on the topic of U of T from now on in the thread.

@16 - Eric Lund
Thank you for being much more eloquent and actually explaining what is wrong with the QM woo taught in this course.

Too much time zone crossing has occurred as of late (with more to come) such that it is amazing that pointing and grunting are not the only form of communication that I possess.

General relativists use notation in which G = c = 1, in which case that the equation would simplify to E = m, not E = c^2, which is just plain stupid -- indeed, the stupid, it burns!

A sibling of mine teaches at Scarborough Campus. All I'm going to say is politics.

Pardon the theological expletive, but, "Good God!!"

This should have been sufficient to produce two firings, not one: "This particular homeopath happens to be the wife of Rick Halpern, the Dean of the University of Toronto, Scarborough Campus, which is the campus where the course was offered this spring."

Whatever happened to rules against nepotism??

I finally understand why quantum quackery is dangerous. Apologies for the long learning curve on this one:

Having gotten through classical physics well enough to make a fool of myself in public, I knew next to zilch about QM until I started reading (reputable books & stuff online, yeah I know) on my own and interacting with working physicists in various forums. So with that description of Landau-Halpern's quantum BS (I didn't watch the video, having just eaten I didn't want to waste a meal and clean the barf off my desk), I envisioned myself as student sitting in that course, knowing about physics what I knew at the relevant age.

Uh-oh.

Because at that age I knew next to nothing about QM, so my mind would have been an open field, ripe for infesting with wacky weeds, plus or minus getting a serious "WTF?" moment about her torture of Einstein. Whether or not that particular WTF would have been sufficient to plant some seeds of doubt to keep the wacky weeds from taking over, I don't know.

But assuming that credulousness follows a normal curve, and the curve is skewed for the population who would take that class: there would be plenty of kids there who would swallow the garbage whole and not even burp. Thereafter going on to spread it like measles among their peers and some day, their patients.

Aack.

No, we can't have that. Glad to hear a bunch of physicists complained.

Best of all to hear she's out of there. I'll guess that everyone involved is going to concoct a placebo press release with a homeopathic dose of excuses (diluted to what level?) to cover their derrieres. But at least she's out of there.

Unbelieveably, bald-faced, nepotism. Like Dr. Oz and his hand-waving wife, the head of UT clearly wanted to a: keep peace at home, and b: steer more Loonies from the Uni coffers into their household. I hope the latest slap on the wrist puts the entire program on notice.

In other news, a local doyenne of the business community in my happy hamlet, has announced in a 3000 word interview penned by our local corporate butt-nuzzling rag, that her company may basically pollute at will because a disembodied Native American spirit told her it was okay as long as she added some solar panels. And she's a reiki practitioner.

That is all.

#14 stewartt1982

You missed the worst of it: e = mc^2 morphed into e=c. She did not even understand the distinction between c and c^2 in her talk.

Overall thought, thevideo was excellent. I am now a total convert to homoeopathy. How exactly do I hold the bottle while I shake it? Oh and can I dilute with a 50/50 mixture of gin and white vermouth rather than water?

I barely got out of Gr 13 Physics alive but the sheer idiocy of her presentation is amazing even to me. Are we sure she is not Alan Sokal in disguise?

As the video played I was also looking at something on the desk and I failed to notice when it ended. The next time I looked it was a man with a white beard (no not him) talking and I looked on with shock at the Caltech sign on the lecture. Woo at Caltech? Ah no, it was James Randi doing a marvellously funny take-down on homoeopathy. Lovely segue

I knew U of T had woo problems but it is a pity to see it spreading like that.

I was under the impression that my local university (Queen's Kingston) was pretty-well woo free--at least nothing in the medical school seems to show up but last winter the student newspaper, The Journal had some articles on a Health Sciences course with anti-vax propaganda. From the article, it looked like the course had been run by the same woman or 2 or 3 years.

It was heartwarming to read about student response to such a course. There had been complaints before but the student government this year reported “Zarzour said, a complaint was filed to him on behalf of an entire class”. http://www.queensjournal.ca/story/2015-02-05/news/queens-prof-slammed-a…

I believe something was finally done, the instructor was eased out of the course and is not teaching it again as far as I can see. To be fair to her, it seems that the course was quite outside her area and she may have just been dropped into it.

Adjuncts don't have a lot of bargaining power it they want to keep eating but one wonders why the Faculty kept her in such a course after all those complaints.

It is to be hoped that she is not spreading too much woo in the courses she does teach. However a quick look at RateMyProf is not totally encouraging “While some of the material was questionable, she definitely did her best” for another course.

Gray Squirrel is correct:
woo invoking QM is often aimed at an audience that has no idea what it's really about and it sounds IMPRESSIVE as well- simultaneously science-y and sophisticated- above the common masses' ken, elevating its interpreter to his rightful place above most of humanity.

Idiotic woo-slingers like Mikey and Gary Null similarly mangle physics - including classical - in order to awe their audiences into a worshipful stupor. Incredibly, they might decorate their physics with a dollop of Eastern Religion as well making for a mighty mashup of ideas most likely beyond their OWN ken.
But then, they may have read a page or two of Capra's book.

Interestingly, Mike, paragon of faux science that he is, isn't content until he has included all branches of research science in his mind-boggling parody of meaningfulness: he opines esoterically upon cognitive psychology which he claims to have studied.

Really. He said that.

I would venture a guess that he mentions it because MOST people do not study cognitive psychology so it has that *mysterioso* aura much as QM does. Similarly, anything with 'neuro-' as a prefix.

Thus, whenever I hear an altie bring up QM, cognition or epigenetics ( but hardly ever JUST genetics) I see it as a shibboleth that this is indeed woo and self-PR, enhanced by delusions of grandeur as well as a canny business sense.

Whatever happened to rules against nepotism??

I can't speak for the Canadian system, and my comments are only relevant if the dean in question was an external hire, but it's common in the US to include a job offer for the spouse in an offer package when hiring at the dean level or above (this has even been known to happen at the assistant professor level, but the likelihood increases with the level of the hire). One of the drawbacks of being in academia is what is called the two-body problem: the difficulty of finding two faculty-level jobs within feasible commuting distance of each other. It's a particular problem in physics: I understand that a majority of the women in the US who have Ph.D. degrees in physics are married to men who have Ph.D. degrees in physics. And many of the ones who aren't are married to people with Ph.D. degrees in some other discipline. I don't know how big an issue it is in other fields, but university hiring committees do have to consider the two-body problem if they want to hire their preferred candidates. So if Halpern was an external hire, hiring his wife as well is not necessarily nefarious. But if he was an internal hire, that's more of an issue.

applied and received f’Whistleblower status’

Owing to a clerical error, Thompson actually received Vuvuzuela-blower status.

After watching that video, I can finally achieve all my wildest dreams by simply ignoring mass! This is quite liberating. I no longer drive to work, but rather float on light beams of energy. What a time-saver! Also, I can eat whatever I want, and I can tell my SO that mass is irrelevant, so pass the cheese fries! Wait, I think we just solved the obesity epidemic. Thanks, homeopathy!

"Thompson actually received Vuvuzuela-blower status."

No, he is a whistle blower, though more accurately a dog whistle blower. Only the dogs can hear him blowing. Or at least they imagine that's what he's doing.

@27 Eric Lund
While I'm Canadian, but can't really speak to how common hiring both members of a couple in the two-body problem is in Canada. I do know that it is common outside of the US as I'm friends with 3 physics couples in Europe who had their spouse receiving a position as part of their contracts. It is probably the same in Canada.

Anyone in academia outside of physics know if this is common practice for other fields?

"General relativists use notation in which G = c = 1, in which case that the equation would simplify to E = m, not E = c^2, which is just plain stupid — indeed, the stupid, it burns!"

Indeed. The relativistic conservation law conserves mass-energy (since they are fundamentally equivalent), replacing the older conservation laws. So if she's reduced mass all she's done is invoke thermonuclear fusion. She has truly bombed.

#3 Truth-Out, huh?

You honestly think no one has seen this before?

"Alex James is a critical scholar of science, culture and social policy. He has a MA in cultural translation from the American University of Paris, France, and a BA in political science from California State University, Sacramento."

Exactly the credentials I like to see in my medical advisers.

I don't know what the funding arrangements are for students in Canada. If it's like Britain, where the kids take out massive loans to pay for their education, and then spend much of their lives paying it back, I think some of them should think carefully about what they've paid for with this course.

And then they should issue small claims lawsuits against the University of Toronto - who, I can guarantee - will pay back some element of the fees for this course, just to make what they have done go away. There would be no shortage of medical and scientific opinion, not only that the course was worthless, but that participants were educationally damaged by it.

Seriously, guys, get advice, sue them, and watch them run.

Oh herr doktor, how you made me laugh. I'm so stealing that.

Newsflash: CDC informant granted Vuvuzuela-blower status!

I got sort of curious and wanted to find out where the whole "Obama granted Thompson ’Whistleblower status’" thing started. It turns out it was an article headlined "Obama Admin Grants Immunity To CDC Scientist That Fudged Vaccine Report…Whistleblower Plans To Testify Before Congress," written by a fellow named Patrick Howley and published Febraury 3 2015 at something called "The Daily Caller".

This is what The Daily Caller says about itself

Founded in 2010 by Tucker Carlson, a 20-year veteran journalist, and Neil Patel, former chief policy advisor to Vice President Cheney, The Daily Caller is a 24-hour news publication providing its audience with original reporting, in-depth investigations, thought-provoking commentary and breaking news.

The original article did not substantiate the headline claim in the body of the article. Never the less, it has been widely repeated by the usual suspects.

Whatever happened to rules against nepotism??

Rules against nepotism? In academia? Not only are there no specific rules against it, spousal hires are a thing, at least at my university.

^ Ah, I see Eric Lund preceded me with a comment about spousal hires. I can say that other forms of nepotism are not exactly uncommon, though, either.

Maybe she discarded mass because, hey, the universe is 90% dark matter and we can't do much with that stuff anyhow, like, you know.

Maybe homeopaths should start invoking dark matter interactions as the next nonexistent reason for their quackery.

"Obama Admin Grants Immunity To CDC Scientist That Fudged Vaccine Report…Whistleblower Plans To Testify Before Congress”

This is obviously false. The Obama Administration is spending all its time these days urging Americans to refinance their mortgages.

Tucker Carlson,geez.I am not surprised in the least.Tucker is a friend of Alex Jones and a 9/11 Truther.

In many ways Tucker Carlson’s a better symbol of the pathetic state of what passes for conservative journalism than even Glenn Beck or the late Andrew Breitbart, to name two of his contemporaries with a much larger following.

The Daily Caller has been known to sink to even lower depths than Glenn Beck.In many ways they could be called the whale.to or Natural News of right wing news sites.

Oh, and she (or maybe the woman in the video, which I haven’t watched) is invoking E = mc^2? That’s special relativity, not quantum physics.

Am I the only one who gets irritated when the momentum term is left out?

Maybe homeopaths should start invoking dark matter interactions as the next nonexistent reason for their quackery.

LMAO

A "former pharmaceutical company employee now making the AVx rounds claiming that she now uses homeopathy 'because Vioxx.' I needed a good laugh.

Denice/Gr*ySquirrel "woo invoking Quantum Mechanics" can only be invoked as mysterioso psychedelia by those who have never actually actually had to cram for Schroedinger equations on a college finals exam, when quantum mechanics is not entirely a bowl of bon bons.

@34 - Brian Deer

I came out of a long stint (12 years in all) of university education 2 years ago. The typical student in Canada has student loans, mine totalled ~26000 CAD or ~13000 GBP at todays exchange rates (loans for only the first 5.5 years ... had a research stipend+teaching assistant salary in grad school).
This value is approximately the average student loan in Canada. Not sure how this compares to the UK.

Payments every month ... thank goodness the pound has done nothing but rise relative to the Canadian dollar.

Liz @35: Wikipedia's article on Tucker Carlson mentions this gem:

Columnist Mickey Kaus quit [the Daily Caller] after Carlson refused to run a column critical of Fox News' coverage of the immigration policy debate.

Carlson also works for Fox News. So yes, we are talking about a suspect source.

@Narad

Am I the only one who gets irritated when the momentum term is left out?

It's at rest, so you can leave out the momentum. And um, the rest mass as well, apparently, because quantum.

@41 - Narad

I become a little annoyed. I can't remember how many times I've come across people with disproofs of relativity based on E=mc^2 ... because how could a photon have energy if m=0!

@ #34

Won't happen. It's not the culture. This will all just go away.

The mass of the universe is negligible because if it were compressed down to the size of a ball (which couldn't happen because of electromagnetic forces) then its mass would be negligible? Did she really say that? And did she really say that if the mass is negligible then the value of "m" is 1? On the other hand, according to Douglas Adams,

The Universe is a very big thing that contains a great number of planets and a great number of beings. It is Everything. What we live in. All around us. The lot. Not nothing. It is quite difficult to actually define what the Universe means, but fortunately the Guide doesn't worry about that and just gives us some useful information to live in it.
Area: The area of the Universe is infinite.

Imports: None. This is a by product of infinity; it is impossible to import things into something that has infinite volume because by definition there is no outside to import things from.

Exports: None, for similar reasons as imports.

Population: None. Although you might see people from time to time, they are most likely products of your imagination. Simple mathematics tells us that the population of the Universe must be zero. Why? Well given that the volume of the universe is infinite there must be an infinite number of worlds. But not all of them are populated; therefore only a finite number are. Any finite number divided by infinity is zero, therefore the average population of the Universe is zero, and so the total population must be zero.

Art: None. Because the function of art is to hold a mirror up to nature there can be no art because the Universe is infinite which means there simply isn't a mirror big enough.

Sex: None. Although in fact there is quite a lot, given the zero population of the Universe there can in fact be no beings to have sex, and therefore no sex happens in the Universe.”

E=mc*2 becomes E=c*2 because m is negligible???? Maybe she has an alternative (sorry, integrative) theory of arithmetic.... Like the strange law of cancellation : To divide 64 by 16, just cancel the 6's. Similarly, to divide 98 by 49, cancel the 9's.

@ stewartt1982:

I think you got away fairly cheaply:
this story may make you feel so-

my cousin died suddenly 10 years ago, leaving a daughter who wanted to be an architect:
she was left an insurance policy from his employer and a year later, money from his father who also died, for her education ( I imagine both together equaled about 400000 in CAD). She acquired a bachelor's degree and a master's and now is working, evaluating buildings,
HOWEVER her mother still has a loan which she needed to compete her terminal degree.
I didn't dare ask how much the loan was for.

@52 - Denice Walter

I count my blessings that I did my schooling in Canada where my tuition from 2000-2012 varied from 4500-7000 per annum (different schools and degrees). For Canada the 26000 CAD loan is about average but it was a bargain compared to a comparable education in the US.

There appears to be no prerequisite for the course, so I suspect it is a "general interest" sort of thing.

Won’t happen. It’s not the culture. This will all just go away.

I agree, especially in view of my remark, above. I think it is actually likely that many people who took the course would welcome more of the same. If it were made into a core course in a normal academic program, then loud howling would certainly be justified.

I don't know how U of T works, but at my former institution of servitude all academic appointments, including those for part-time sessional instructors ("adjunct", in many places) came from the Board of Governors, so there was some barrier to crass nepotism or other favoritism.

@ Mephistopheles O'Brien

On the other hand, according to Douglas Adams,

IIRC, following the passage you quoted is a very appropriate footnote about UToronto situation, stating that this diatribe about the bigness of the universe is that you get for leaving the doors open during lunchtime and letting the first idiot walk in and writing down any sort of nonsense.

It is hardly necessary to criticize Werner's arithmetic. She doesn't even comprehend the difference between mass and volume.

If one were to make a bowling ball with a mass of one percent of the total mass of the universe, and barring the existence of other objects of significant mass, how far would a bowling pin have to be from the ball to keep it from falling over/flying a great velocity due to the ball's gravity?

I count my blessings that I did my schooling in Canada where my tuition from 2000-2012 varied from 4500-7000 per annum (different schools and degrees). For Canada the 26000 CAD loan is about average but it was a bargain compared to a comparable education in the US.

My undergrad tuition was actually about $5000 a year*, back in 2005-2009. I did go to the cheapest four-year college in Washington state, though.** Being dirt poor actually had some benefits, in that in addition to a Pell grant, I also got a grant from the state of Washington that pretty much matched it. Jobs and scholarships rounded out the rest, which is how I managed to graduate without any debt. Getting a PhD, of course, is not something a smart person pays for, either.

I was honestly shocked and appalled at how expensive undergrad tuition is even for in-state students at the University of Michigan these days.

*I even paid it out like half of pocket during my second year, when I didn't have any financial aid except a couple scholarships. (Long story.) That was the year I lived in things like sheds and sailboats.

**I picked it because it was cheap and I heard you could get in fairly easy with a GED, and apparently they didn't look askance at 16-year-olds, not realizing that I probably could have gotten into most places I'd have wanted to. I'm glad I went there, though, in hindsight.

I count my blessings that I did my schooling in Canada where my tuition from 2000-2012 varied from 4500-7000 per annum (different schools and degrees). For Canada the 26000 CAD loan is about average but it was a bargain compared to a comparable education in the US.

My tuition back in the '80s was $25,000 a year IIRC, but not many paid rack rate. I was left with $10,000 in loans to be repaid over 10 years.

@57 - JP
I did my undergrad at the University of New Brunswick (UNB) (the Canadian province not the city in NJ). A small university, with a relatively low tuition, and not particularly world renowned. I picked it because it was in my home city and I could live at home. In hindsight I think it was for the best ... a good education with small class sizes where one was able to get know their professors (even in 'large' first year classes). Having demonstrated labs at UofT where class sizes were much larger (my graduate level courses were ~the same size as my more specialised undergraduate 1st and 2nd year courses) I think I choose wisely for undergrad.

Getting a PhD, of course, is not something a smart person pays for, either.

I always loved getting my stipend at the beginning of the year, then immediately seeing a large chunk disappear to pay tuition. I'm sure there is a good reason (or at least a reason) but not charging tuition and paying a smaller stipend somehow seems easier.

I did my undergrad at the University of New Brunswick (UNB) (the Canadian province not the city in NJ). A small university, with a relatively low tuition, and not particularly world renowned.

I went here: I wouldn't say it's renowned, but it seems to a growing cachet the further east you go. "Oh, you went to Evergreen," I remember the chair of my department remarking when I was visiting the campus five years ago.

a good education with small class sizes where one was able to get know their professors (even in ‘large’ first year classes).

Yeah, same with Evergreen. The whole "getting to know your professors" aspect led to near-radioactive recommendation letters, I'm pretty sure.

I was also more than used to seminars by the time I got to grad school, too, not to mention writing research papers. I didn't realize just how good I had it until I heard some stories from my Russian students about 400-student lectures involving something called an "i-clicker."

I always loved getting my stipend at the beginning of the year, then immediately seeing a large chunk disappear to pay tuition. I’m sure there is a good reason (or at least a reason) but not charging tuition and paying a smaller stipend somehow seems easier.

I get a notice that I've been billed for tuition, but it's just paid on my behalf, which, yes, seems much easier. I also don't know if I could cope with that much money being deposited in my bank account and then parting with it immediately afterward.

Not unbalanced, no. Unhinged is the word.

I count my blessings that I did my education post-Marine Corps so that Uncle Sugar picked up the tab for about 80% of it.

(whenever some well-meaning citizens thank me for my service I thank them for my master's).

From mothering.com on the piece. Haha.

"You posted "Required Readings/ Viewings for this week:"
What about the other 11 weeks? Easy to judge a class based on one week of required readings.

Besides, when you talk about a topic for a college class that week's readings are usually all about that specific topic. Looks like that week was about vaccine critics. This is a valid topic for research and study.

Poor woman was trying to get her students to actual compare this information to the normally accepted beliefs and studies to see if there was a difference in methods, results, implications, etc. Too see how they differed in logic, assumptions, etc. It's really quite an exquisite example of a college class.

It's unfortunate that book burners still exist. Freedom of literature, language, and science unfortunately doesn't just mean agreeing with whatever is considered true according to 1. the government, 2. religion, 3. the medical establishment, 4. your family, 5. etc.

The purpose of a college education is to read things you may or may not agree with and to learn to handle them - to critically analyze, to interpret, to read between the lines. If you believe that this woman had no right to teach something that you disagree with then you have other issues relating to freedom of speech and education. I wonder if you ever had to read and study something you didn't agree with? It's terribly valuable for cognition."

They really are something else...

" It's terribly valuable for cognition"

Yiiiiii! Another one on the cognition!

The purpose of a college education is to read things you may or may not agree with and to learn to handle them – to critically analyze, to interpret, to read between the lines. If you believe that this woman had no right to teach something that you disagree with then you have other issues relating to freedom of speech and education. I wonder if you ever had to read and study something you didn’t agree with? It’s terribly valuable for cognition.”

This is established scientific fact , not a comparative literature course. Then again, most all of the sMothering critters aren't real big on science and critical-thinking.

What about the other 11 weeks? Easy to judge a class based on one week of required readings.

They couldn't find the syllabus (PDF)?

Tucker Carlson,geez.I am not surprised in the least.Tucker is a friend of Alex Jones and a 9/11 Truther.

I am given to believe that he aspires to Dead Breitbart levels of relevance. I doubt that he is as sincerely deranged as Jones; he's just a skeevy little ratfecker who goes where the money is. Also he wears a bowtie.

@hewholaughs last:

If you wonder why your latest comment didn't show up, it's because you changed your e-mail address and the system saw it as a new commenter, and the first comment from all new commenters automatically go to moderation. This reminds me of the behavior of a certain other commenter, who used to change his e-mail address to various variants practically every day, if not every hour. I got fed up with it and no longer put up with such behavior. If you can't be bothered to use a consistent 'nym and e-mail address, I can't be bothered to re-approve you each time you change.

No, I didn't approve the comment. Use the e-mail address you started with if you want your comments to show up.

http://www.kevinmd.com/blog/2014/06/homeopathy-invaded-er.html

@ #1, #2, #3

999 times out of 1000 someone laughing on their own is indicative of psychosis, not victory.

999 times out of 1000 someone laughing on their own is indicative of psychosis, not victory.

Oh jeez, maybe that's why I have such a hard time getting a clean bill of mental health.

Naaaah, it's probably the extensive raft of pathologies.

Denise @ 26: Thanks, and yeah they like "neuro-" too. The worst of it is The Singularity, utter quack nonsense with the full endorsement of Google. The flashy garbage attracts its deluded devotees, but the flip side of that coin is that legit work in any of these areas can get tarred with the same brush, so everybody loses.

Eric Lund @ 27: The two-body problem: good point. I've heard about this before and it goes hand-in-hand with a particularly obnoxious aspect of the academic world: Shuffling people around geographically until they get tenure somewhere (or starve), by which point they have become completely disconnected from any sense of geographic roots (or they've starved).

Barefoot @ 43: But psychedelia is _good_, as long as one doesn't overdo, and as long as one doesn't engage in "psychedelic fundamentalism" ("it felt powerful therefore it's literal revealed truth as given"). Self-skepticism is a necessary skill for those sorts of things, as with any other state of consciousness including our "normal waking state" with all of its emotional biases.

Annie @ 63: That's all fine & fair in the humanities, for example literature. But science has right and wrong answers (as well as some very large gray zones where we don't have clear answers yet), and the answers don't care about our feelings. Try making a paper airplane that looks like a flower and see if it flies. See if it flies any better if you "really put your heart into it." And the problem with "believing in" wrong answers (such as homeopathy and anti-vax) is that trying to act on those answers makes people sick and kills them. Now imagine building an airliner that looks like a flower, and see how you feel about 200 dead bodies strewn across the runway. Does that make sense to you?

@Gray Squirrel

Annie pulled that quote from mothering.com. I gather from the "haha" that she's most likely not in agreement with it. ㋡

My tuition back in the ’80s was $25,000 a year IIRC

You're probably including room and board in that figure, and possibly some other fees. I recall my annual tuition bill (at a private university known among other things for its high tuition costs) crossing the $10k line while I was an undergraduate. The nominal dollar cost of attending the flagship state university of my state as an in-state student is now higher than that. And many of the students here are from out of state--even out of country (the Chinese are the most obvious contingent due to their numbers--it's no longer weird to hear conversations in Chinese on the streets of Universityville--but we see students from other countries as well). Foreigners can sometimes get work-study positions and private loans, but for any other kind of financial aid in the US you have to be a US citizen or permanent resident.

I find it disturbing that Integrated medicine is basically sneaking into Universities. After I read this article I went onto my school website and sure enough it was there. Acupuncture, chiropractic, and biofeedback was all there. What's worse is that it's based on the medical and health sciences campus.

I dropped a sadarian screed at SBM in reply to Steve Novella's post on this today (7/8).
https://www.sciencebasedmedicine.org/university-of-toronto-coddles-quac…

While much of this applies to Orac's post as well, I commend the blinking box for mentioning Rick Halpern by name (this is rather obviously his show) and noting that his wife's class was a Special Topics course offered under the auspices of the Anthropology Department.

A couple corrections: "Aand... she's gone." "This should have been sufficient to produce two firings, not one." Nope. She wasn't fired, and she was never really 'there' in the first place. The UT PR peeps are trying to make the U seen more proactive by saying "she is no longer on the staff," hinting that they 'did the right thing' by dumping here. She was teaching one class as an adjunct. That's not being "on the staff". It's temp work; contracting; ends each term at the end of the class. What has happened is that UT has declared they will not enter another contract with Landau-Halpernwas to offer a section of their Special Topics course devoted to CAM.

The happy noises you're hearing coming from the vicinity of Scarborough are the chuckles and sighs of relief from the Health Studies faculty, as the controversy ginned up over the class has gotten Rick Halpern off their back, and he'll no longer be able to meddle with their curriculum to help his wife promote her homeoathy practice.

As Delphine says, this will all 'go away' because they're not going to dump Halpern over something as petty as getting his wife an adjunct gig. Given her dubious credentials even for a Health Studies course in woo, had he bullied Anthro into opening any kind of continuing position for her (say, a half-time instructorship) this bad press MIGHT pose a real threat to his position. As it happened, he's probably in the dog-house with his bosses and will be slowly bled dry by being denied promotion or new perks, and tighter reign/oversight on whatever power he has.

OF COURSE, Vivek Goel is going to defend everything and everyone involved in public as that is seen as 'protecting UTs reputation'. That's how bureaucracies work: deny everything to the outside world and TCB in private. The knives come out behind closed doors...

What’s next? Teaching young earth creationism in biology classes? Teaching astrology in astronomy class?

I don't know, but if so that will be the doing of the Pharmacy Department or an Integretive Medicine program in the Health SCIENCES. This was a class in Health STUDIES; ain't the same thing. Creationism, astrology, homeopathy, and anti-vax are not only allowable subjects for Anthropology, but quite pertinent exactly because some, uhh, 'questionable things' are going on under the rubric of 'legitimate science'.

Yes, Beth Landau-Halpern should never have been contracted to teach in this program – even if she kept her pedagogy free of her own partisanship, she has huge COI with the public positions she's taken in her 'professional' practice via endorsing CEASE 'therapy' and homeopathic treatment for ADHD. But Vivik Goel is right about one thing – as part of an Anthro program, Health Studies students ought to be well prepared to consider the course materials IN CONTEXT, in a spirit of critical analysis, and inquiry., as that context WILL have included enough material on where legit medical science stands on CAM. This isn't a field where students memorize the content of authoritative readings, and get evaluated by machine scored 'objective' tests. The purpose of assigning a reading is to generate student discussion and debate around the claims of the author, and the proper role of the instructor is to keep the discussion on track, and pose key questions via the Socratic method, to be a cheerleader for thinking-through the topics, not for any given perspective on them..

A kind of on topic sort of rant:

It drives me crazy. All kinds of woo. From antivax explanations that go too deeply into how vaccines might cause damage in the body to how some supplements or device or treatment might work ('oh! it's quantum!) or trying to argue why there isn't one major conspiracy that conveniently ties them all together to makes them work.

How in the world do you ever get smart enough to be able to explain that "quantum" is not a defense for homeopathy? Especially when you know enough to know quantum deals with matter and energy at atomic and subatomic levels, and you learned Avagadro's number in ninth grade chemistry, and nothing has demonstrated that water has memory.

For that matter, you are immune to the natural thing because you had a wonderful time learning about organic chemistry molecules in advanced science senior year, understand they have their own little names and end up showing up in the compounds... that everything is a "chemical" or can be described as a chemical name.

But I am too stupid to argue with antivax people or quantum wooists, iridologists, or even a really enthusiastic massage therapist. I get so frustrated with this.

Orac mentioned Lionel "derailed train" Milgrom. That bozo makes Humpty Dumpty look like Bertrand Russell. When he uses language, you can guarantee that whatever he tries to make it mean is WRONG, by which I mean it means something utterly different in the communities that formed the concepts and use them in actual, you know, thinking. An equal-opportunity crap artist, is manglings of 'Theory' are as loopy-awful as his manglings of 'Science'. Or worse, considering the wider acceptable free-play in the Humanities, from which he's still way, waaay off.

I'd say it's not his stylings per se that can melt the brains of honest-to-goodness physicists AND honest-to-goodness scholars of cultural studies/PoMo/yada-yada-yada. The melt comes from the heat of anger at the thought that even one human being might consider Milgrom knows what he's talking about. Thankfully, most 'theory' folk are safe from combustion in fits of quintillion K burning rage, as they have never heard of this putz, and have no cause to encounter his hyper-garbage in the course of their labors.

Yes, ignorance of the depths of WTF can be bliss. I'd curse Orac for the RI post that pointed me to Milgrom, but there's something to be said for the empathy developed by sharing another's pain... I feel you, my brother, I really do.

Oh, I have more posts about Milgrom. He's the gift, as far as blog fodder goes, that keeps on giving...

I'm reminded of the course John Wayne, Father of NATO.

So what does your middle ground look like?
Because there is something a bit binary about it. Either you vaccinate enough people to either eradicate a disease (which we can do with significant effort and expense) or keep it mostly at bay or you do not. Because lets work really hard to make sure the grandkids don’t even need some of the sedef vaccinations anymore because it is gone makes more sense to me than lets work really hard to make sure the disease will always be with us because we will not ever do anything to make sure enough people are vaccinated against anything ever again.
Vaccinating 50% of the people 50% of the time (the absolute middle) just ensures the diseases can never be eliminated and no amount of sanitation or vitamin pills is going to do what the vaccine will.

Or do you pick 50% of the vaccines to keep mandating and just hope enough people volunteer for the rest that you never come across someone contagious with the other things?
Do you include the harms from the diseases in determining where “middle” is?
Do you just chuck all the science because we don’t actually spend the time and money it would take to fix the system, and do you acknowledge there can be bad science on both sides of the debate or is most pro-vaccine science bad and most anti-vaxx science is good no matter how many times it is found to be problematic? Or just put it all in a blender and hope the sludge is about 50% right

FYI the exact copy of my comment @ #18 by a sound alike name was not done by me.

Because the nonsense comment #81 is spam.

Well, it's not exact. I see a link has been added, that I wouldn't click for love or money.

TraceRT shows me that the link @81 goes to a server in Turkey. I'll ZAG our host a note and suggest the comment be removed.

The pdf of the course description is no longer available at https://ahautsc.files.wordpress.com/2015/01/hltd04-alternative-health-p…

I knew I should have downloaded it.

Seems to me Werner (and no doubt the rest) are applying homeopathic theory to physics. Namely, take a quantum physics theory, dilute it down until there isn't a particle of the original truth left, and parcel it as Quantum-Physics-Based Homeopathic Therapy.

E=mc*2 becomes E=c*2 because m is negligible???? Maybe she has an alternative (sorry, integrative) theory of arithmetic…. Like the strange law of cancellation : To divide 64 by 16, just cancel the 6’s. Similarly, to divide 98 by 49, cancel the 9’s

I was shocked to hear Indre Viskontas of Inquiring Minds podcast support this class at her alma mater! She presents a master class on how one can end up over one's head outside their field of expertise...

It could get worse. There's Aaron Carroll writing stuff like this in the NYT:

http://www.nytimes.com/2015/08/11/upshot/labels-like-alternative-medici…

There's a germ of an idea I agree with, but it's slathered so deep in false equivalence between quackery and science that I can't stand it.

Quackademic medicine in Connecticut

oracknows — Tue, 14 Oct 2014 04:00:27 +0000

Quackademic medicine in Connecticut

A common topic that I’ve written about since the very beginning of this blog is the infiltration of quackery into what were formerly bastions of science-based medicine. Most recently, I lamented just how far this process has progressed at the Cleveland Clinic, as evidenced by its recent opening of a clinic devoted to the quackery that is functional medicine and, not long before that, its opening a clinic run by a dubious naturopath practicing traditional Chinese medicine. That’s not even counting its long-standing credulous promotion of the faith healing known as reiki and the use of acupuncture on children.

Unfortunately, the Cleveland Clinic is far from the only bastion of what I like to call quackademic medicine. Far from it. I was reminded of this when I saw a story yesterday pop up in my Google Alerts on alternative medicine. It’s entitled Alternative medicine gains steam in Connecticut, an article that's also on the Connecticut NPR website. Where in Connecticut is it gaining steam? Yale University, that’s where. Well, there and the University of Connecticut. Of course, Yale is the home of David Katz, whom we’ve met several times before, such as when he advocated a “more fluid concept of evidence” and claimed that it is necessary to embrace quackery in order not to “abandon patients.” If this article is any indication, it’s only getting worse there.

Now, one thing I have to be clear about here is that I have no objection to studying natural products like black cohosh and capsaicin. Indeed, the appropriation of such substances by “integrative medicine” is, as I’ve said time and time again, a “rebranding” of natural products pharmacology (also known as pharmacognosy) as somehow being “alternative” or “integrative.” It’s not. On the other hand, as I like to say, black cohosh and other herbal remedies like it are drugs, impure drugs with a high degree of lot-to-lot variability, but drugs nonetheless. They also tend to be oversold drugs in “integrative medicine,” with the claims of efficacy made for them far exceeding their actual promise, but, unlike so much else of alternative medicine, they are drugs and therefore not implausible as modalities like “energy healing” are. For example, there’s John Geible, a surgeon at Yale:

Geibel, vice chairman of the Department of Surgery at Yale, noted that genetic screening has been effective in determining whether some women will get breast cancer. “But even if you come in and perform the mastectomy, it’s difficult to impossible to remove every single (cancer) cell,” he said.

Earlier studies have shown capsaicin’s ability “to slow down or even stop the machinery of (cell) division,” he said, pointing to one in which capsaicin stopped the growth of prostate colonic tumors in a dish. What if, he posited, after a surgeon has removed a malignant tumor from a breast, the doctor can “coat the underlying tissue area with a capsaicin-based preparation to prevent any residual cells” from reproducing?

Geibel said he initially tested capsaicin on breast cancer cells in a culture to determine the dose and the best way to deliver it. “The next phase is to now take some tissue from an individual,” he said.

Why capsaicin? Why not any number of other drugs used against breast cancer, like paclitaxel or compounds that are known to slow down or stop brast cancer tumors in a dish? I mean, seriously. Capsaicin can indeed inhibit the growth of breast cancer cells, but it requires a high concentration. For instance, this paper testing its effect on MCF-7 cells (a breast cancer cell line) found that at a concentration of 200 μM, decrease in cell viability is only around 50%. That’s nothing. No wonder Dr. Geibel is talking about topical application in the surgery bed. There’s no way to achieve such high concentrations in the blood by oral ingestion, and even at that high of a level the effects are at best modest. Remember how I discussed IC₅₀? That’s the concentration required for 50% of maximum effect of a drug. Remember how I discussed how an IC₅₀ above 10 μM tends to be problematic for a cancer drug? Well, here we have an estimated IC₅₀ of close to μM for capsaicin for the endpoint of cell survival. For apoptosis (programmed cell death), eyeballing the graph in the paper I estimate the IC₅₀ of around 75-100 μM. All in all, it’s very unimpressive, even in cell culture. Another paper found roughly the same thing for a number of breast cancer cell lines, an IC₅₀ ranging between 50 and 200 μM. Granted, it did a reasonable job inhibiting the growth of breast cancer xenografts.

But I don’t really want to dwell on natural products. As I said before, I have no real objection to studying things like black cohosh and capsaicin. I just doubt that they show much promise and don’t like how “integrative” medicine has co-opted such products as somehow being outside of “conventional medicine” when they aren’t. What I really don’t like is this:

With training in molecular and cellular biology, Dr. Gloria Gronowicz, a professor at the UConn Health Center, has long been looking into the effects of energy healing on tumor growth and metastasis, working most recently with a breast cancer model in mice.

Energy medicine, which includes Reiki, qigong and a practice named Therapeutic Touch, actually involves no direct touching of a patient or an object being studied. Rather, practitioners work with what they say is the energy emitted from their hands, which they call biofields. A paper published in May by Gronowicz and others, in the Journal of Complementary and Alternative Medicine, said that Therapeutic Touch had prevented cancer cells in a breast cancer model from spreading, though it had not shrunk the size of the primary tumor.

“Let us use everything to help patients,” Gronowicz said of the growth in research into alternative treatments.

We’ve met Gronowicz before. It was six years ago. She was doing therapeutic touch on osteoclasts in cell culture and claiming that it could stimulate them to grow. Her results were, as I described, underwhelming. so is this paper, because it’s not a paper at all. It’s an abstract for a poster for the International Research Congress on Integrative Medicine and Health (IRCIMH) in Miami in May. So, what we have here is an abstract for a poster (the lowest form of scientific publication) being misrepresented as an actual scientific paper, but even if it were a paper it would be in a bottom-feeding alternative medicine journal. Anyone wonder why I’m not impressed?

Basically, it looks like an exercise in cherry picking. Breast cancer cells (4T1, a mouse mammary cancer cell line with which I am quite familiar) were injected into the foot pads of mice, which were divided into three groups. One group got therapeutic touch; one got “mock therapeutic touch” (I’d like to see that); and the other got saline injections. At 26 days, tumor volumes were measured and serum collected for 32 different cytokines and chemokines. Metastases were measured, and cells isolated for a number of assays. There’s a big problem, though: Nowhere is it mentioned that the therapeutic touch practitioners were blinded to experimental group or that those collecting the serum, measuring the metastases, or the tumors. and, of course, it’s just an abstract for a poster presentation.

OK, so we know that both Yale and UConn are deep into the woo. Yale has David Katz plus a large integrative medicine program. UConn has Gronowicz and its own integrative medicine program, complete with credulous treatments of homeopathy, Ayurveda, naturopathy, and, of course, traditional Chinese medicine. What’s really irritating about this article is that it is written from the standpoint of pure credulity, full of false balance. Actually, it goes beyond false balance. It’s downright supportive of integrative medicine and goes out of its way to paint critics as close-minded:

But alternative medicine continues to have its critics. They can be found on such websites as Quackwatch.com and The Skeptic’s Dictionary. Dr. Steven Novella, a researcher and assistant professor of neurology at Yale School of Medicine, founded the take-no-prisoners website Science-Based Medicine, of which he is editor. On Sept. 29, the site’s managing editor, Dr. David Gorski, a surgical oncologist, posted his latest attack on alternative medicine: “Quackademia Update: The Cleveland Clinic, George Washington University, and the continued infiltration of quackery into medical academia.”

A growing number of researchers are ignoring that skepticism by using scientific methods to measure and quantify the efficacy of unconventional treatments.

See that? Got the idea? Critics are “unscientific”! So the brave intrepid doctors of “integrative medicine” have just decided to ignore them! They’re “ignoring them” by using scientific methods. Except that they’re not. Not really. They don’t take basic science and prior plausibility into consideration. They study mystical magical faith healing like reiki and its bastard offspring made even more palatable for “Western” consumers, therapeutic touch. All the stuff about diet, exercise, and natural products like black cohosh is the Trojan horse. These modalities seem plausible and follow in the tradition of existing scientific study of natural products. Once the Trojan horse has gained entrance to the fortress of medical academia, the quackery leaps out, in particular traditional Chinese Medicine, the various magical mystical “energy medicine” techniques, and a whole host of other quackery.

Actually, the Trojan Horse has already gained entrance to a number of academic medical centers. Combatting that is why I do what I do.

oracknows Tue, 10/14/2014 - 00:00

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Aren't New Englanders supposed to be practical and hard-headed people?

That Trojan Horse clearly needs more capsicum.

@Shay: Yale is an Ivy League university, which means that they can hire pretty much any professor they want, from anywhere in the world. There is some visa paperwork to be done if the person is not a US citizen or permanent resident, to certify that the person really is the best qualified, but this is usually a minor inconvenience when you are hiring at Yale's level. Note also that New Haven is (just barely) part of the metro New York City area, and we know that NYC is a hotbed of alt med, because it is home to many special snowflakes with lots of disposable income. At least one major alt-med guru (Gary Null, IIRC--Denice can correct me if I am wrong) either lives there or has lived there.

I don't know what's up with UConn. The main campus is in a town called Storrs, in a semirural part of eastern Connecticut, but that is not necessarily where the med school is located.

Dr. Steven Novella [...] founded the take-no-prisoners website Science-Based Medicine

"take-no-prisoners". Ah!

If those entrenched skeptics would only accept to be reasonable.

Oh, and about capsaicin: That's the compound which makes hot peppers hot. I eagerly await the hilarity which is sure to ensue when alt-med types extol the "ancient wisdom" of Indian and Chinese diets that make heavy use of hot peppers. Never mind that all species of hot pepper are native to the Americas, and did not become part of Asian cuisine until about 1700 when Dutch traders brought them across the Pacific. Or that many Chinese regional cuisines, particularly in the east and north (e.g., Cantonese and Mandarin), do not actually make significant use of hot peppers.

If only it truly were like the Trojan Rabbit where they forgot to get inside of it before sending it in...

"-King Arthur: What happens now?
-Sir Bedevere: Well, now, uh, Launcelot, Galahad, and I, uh, wait until nightfall, and then leap out of the rabbit, taking the French, uh, by surprise. Not only by surprise, but totally unarmed!
-Arthur: Who leaps out?
-Bedevere: U-- u-- uh, Launcelot, Galahad, and I. Uh, leap out of the rabbit, uh, and uh...
-Arthur: Ohh... (he and Lancelot slowly put their hands to their heads at the realization that they messed up)
-Bedevere: Oh. Um, l-- look, i-- i-- if we built this large wooden badger--
(twang of a catapult is heard from the French castle and the Trojan Rabbit comes flying towards where the knights are hiding)
-Arthur: Run away!
-Other knights: Run away! Run away! Run away! Run away! Run away! Run away! Run away!
(Trojan Rabbit lands on one of the pages)"

Eric Lund is correct: Null lives in NYC and owns estates in Florida and Texas ( see his website for photos of the two latter places- filed under health retreats).

Woo-meisters seek out areas where well-to-do people live because they can afford to pay for products and services. NYC and its suburbs are the flames that attract these moths. I'm sure that having large communities from east and south asia doesn't hurt either.

Oh dear. Connecticut is going in a sad direction. One of their candidates for the legislature may be quacky too. http://www.examiner.com/article/cook-littman-legislative-candiate-appea…

Come on over to the moments on the NPR article and give my Disqus pseudonym a hand. Or at least wave one . . .

That location on my last post autocorrected. It was supposed to be "hahd tellin' not knowin'."

It’s an abstract for a poster

Just wondering, but wouldn't the abstract be even smaller than the poster?

These types of program tend to be the result of rather sizable charitable donations from woo-inclined philanthropists. Non-profits are generally loathe to turn down gifts with lots of zeroes, and so they rationalize their acceptance and creation of fairy studies programs like at Yale and UConn.

And remember, just because you're held aloft as a reputable educational institution doesn't mean that all of your faculty are grounded, science-based folks. Just look at Harvard and John Mack, he of UFO abduction/recalled-memory fame.

One group got therapeutic touch; one got “mock therapeutic touch” (I’d like to see that); and the other got saline injections.

In other words, this is a comparison of three different kinds of placebos. Or maybe only two, since I'm not sure what the difference would be between the first two--in neither case is the subject actually touched.

I realize the standards for studies in lab mice (or other non-human creatures) aren't as strict as for studies involving human subjects, but I am trying to envision a non-conflicted IRB that would consider this proposed study without breaking into fits of uncontrolled laughter, and I'm not succeeding.

@Eric Lund

UCHC isn't on the Storrs campus, it's located in Farmington, CT, west of Hartford. There's about an hour's drive between the two campuses.

UCONN has, unfortunately, started more sCAM offerings through its medical program in the last decade. It makes me very sad to see they're delving deeper into the woo.

Earlier studies have shown capsaicin’s ability “to slow down or even stop the machinery of (cell) division,” he said, pointing to one in which capsaicin stopped the growth of prostate colonic tumors in a dish.

That doesn't mean capsaicin represents a promising therapy. So does a blow torch.

@ Todd W.:

Oh I know: John Mack. Heh.
I actually read his book based on the experiences of those who were 'abducted'.

I actually read his book based on the experiences of those who were ‘abducted’.

"Oh, no! He's being alienated!" -
Firesign Theater, "Everything You Know Is Wrong", 1975 or so.

One of their finest works.

The banner ad I got is an offer to study holistic nutrition online! I even get a free class if I want!

I wonder what happened to the creepy old guy with the muscles?

Even a 9 year old could figure out that therapeutic touch isn't real. It's really quite reminiscent of the Emperor's New Clothes.

John Geible wants to rub capsaicin in the open wound where a toumor was just removed? I know it's more complicated than that, but talk about salt into an open wound! It hurts just to think about. I hope the patients would stay under until the pain wore off.
Eric @13: Mice don't like to be touched or held a whole lot (because you are a giant scary predator), so I can't imagine that they're big fans of any of this "touch" stuff, even if it doesn't involve much touching.

Actually, how would that even work? Do you do it to the whole cage of mice at the same time, or do you take them out one at a time to "not" touch them? Or do you just think really hard at the whole rack?

Eric Lund #5 says ""That’s the compound which makes hot peppers hot.

Rats do not develop a preference for peppers, even after repeated laboratory exposure.

I should think the rats would not, considering how they were repeatedly *introduced* to peppers within the soft, candlelit laboratory setting.

Incidentally, does anybody remember what the *objective* modified Scoville scale test was that put the pepper on the rat's anus to measure the 'twitch'??

I forgot the magic g-words and just keep getting ads for Rat's Red Ass hot sauce.

^^ {I don't even know that poser}

Orac,

http://imgs.xkcd.com/comics/exploits_of_a_mom.png

Given that capsicum is the active ingredient in pepper spray, rubbing high concentration capsicum on the skin sounds painful. There's a reason I wear gloves when chopping habaneros.

Earlier studies have shown capsaicin’s ability “to slow down or even stop the machinery of (cell) division,” he said, pointing to one in which capsaicin stopped the growth of prostate colonic tumors in a dish.

Correct me if I am wrong, but I imagine that after mastectomy the patient wants the wound to heal, so "stopping the machinery of cell division" is not in itself desirable. Is there any evidence that capsaicin inhibits tumour-cell division more than healthy cells? Geibel isn't showing any.

I don't want to stray too far off topic but begins off topic grumble perhaps this could be a mood of the time. In the USA/Europe, there seems to be a revolt against Enlightenment era ideas such as reason and individuality and also some older traditions in favor of new-agey replacements.

New Age is neither new nor improved, but never is is clearly explicated with a compare and contrast statement.

Why would institutions of high repute like Yale and the Cleveland Clinic get involved with these dubious treatments? Does $ have anything to do with it?

Money has a lot to do with it. these non-evidenced based practices are covered under the Affordable Health Care Act and the alternative medicine industry reaps $34 billion annually.

Well, yes and no. Actually, if you look at most "integrative medicine" centers, they tend not to make as much money as a lot of skeptics think they do. Some even have a hard time breaking even. Moreover, as Jann Bellamy has pointed out, despite harping on the ACA, these sorts of quackery are not covered under the ACA unless their practitioners are licensed by a state. In states that do not license naturopaths, for instance, ACA insurance plans are not obligated to cover naturopath services. Why do you think there's been such a renewed drive by quacks to win state licensure?

But back to these centers. If you look at most of them, you'll see that they tend to be started by funding from a single wealthy donor. I'm not saying money isn't important. However, if there's one thing I've learned, it's that skeptics tend to seriously overestimate the financial motivation for hospitals to open these centers.

Storrs, home of the main UConn campus is just a bit East of the Hartford metro area. Farmington is a closer-in 'burb SW of Hartford proper. So basically, the UConn Integretive Medicine program is operating in the shadows of the head offices of most of the major health insurance companies in the U. S. That's basically all there is to Hartford's economy. If that area is attractive to woo-meisters due to the presence of well-to-do special snowflakes, we would mainly be talking about insurance industry executives. How fun!

There are basically only two things in New Haven -- Yale and poor Black people. The commuter trains to NYC do go to New Haven, but there's no reason for anyone who works in the city to live that far out. But Yale Hospital is totally the Big Dog of medicine in CT, so I'm sure they pull in lots of patients from all the towns between New Haven and NYC where plenty of well-heeled commuters reside -- and just the well-heeled in general who only go into the City now and then. Despite there being huge areas of poverty in all the bigger cities (Hartford, New Haven, Bridgeport...) CT has the higher per capita income of any state.

Hey Orac, Bic here ... Bic Mitchum. Weren't you exposed as Orac the Nipple Twister by some other guy that keeps up with law-suits against you and your (fleeting) colleagues. Answer soon. LOL.

Hey, hey, hey Orac, Bic here ... Bic Mitchum. Weren't you exposed as Orac the Nipple Twister by some other guy that keeps up with law-suits against you and your (fleeting) colleagues. Answer soon. LOL.

Fucktard Orac ... your sleazy game is now exposed. LOL!

Hey Orac!, Bic here ... Bic Mitchum. Weren't you exposed as Orac the Nipple Twister by some other guy that keeps up with law-suits against you and your (fleeting) colleagues. Answer soon. LOL.

Hey hey Bic. I can see why they call you bic, you sure do like to write a lot. America really does have the best education system in the world.

Such eloquence and insight. Wow.

I see that there's a proud representative of the Pattimmy Memorial Society to hand.

@Sadmar

I'd argue that there's more to New Haven than just "Yale and Poor Black People" - Yes, it's on the 95 corridor, but then again so is Bridgeport.

There's actually quite a bit to do in New Haven - jazz festivals, foodie festivals, etc. It's quite culturally diverse.

^ In case that wasn't clear enough,

some other guy that keeps up with law-suits against you and your (fleeting) colleagues.

To wit:

In 2010, "I pointed out earlier, Barrett made some serious mistakes in his Texas campaign, and if I have my way, and I usually do, Barrett is dead meat. If I have my way Barrett is going to get indicted,. and he'll end his days as Big Willie's giggly girlfriend...." (My best guess is that this has something to do with Stemp v. Care Clinics. And what actually usually happens when Patty "has his way," as it were.)

In 2011, "The Maryland Board of Physicians is DEAD MEAT." (Yah, no. Père et fils went out whimpering.)

In 2012, "I have read selected excerpts from Depositions conducted in England. In short, Deer, Godlee, and the BMJ are dead meat." (Heh.)

In 2013, "Barrett, et al, are dead meat. There are specialized companies out there who go and find assets after a judgment." (Patty's rules of "having my way": early, often, and unsatisfyingly.)

Weren’t you exposed as Orac the Nipple Twister

"Exposed"? Tim Bolen calls Orac "the nipple ripper", as a sophisticated and classy* reference to Orac's profession as a breast cancer surgeon. That tells me all I need to know about Bolen.

* Sarcasm, in case anyone takes me literally.

It seems that Pat Tim has united squabling anti-vaxxers ( see Bolen Repor t/ on Health Freedom Congress Oct 2013) so perhaps the autism puzzle will soon be solved. He gathered together such luminaries as Piper-Terry,:Larson, BLF and the Segals to hobnob with Health Freedom Fighters who are legion ( esp in Texas).

So quake in your Ferragamos/ Laboutins, brother and sister sceptics!

what worries me more about capsaicine is its ld50 being on the same order as nicotine. oh, and iv, ip and sc being about 2 orders of magnitude more toxic than oral or dermal...

http://www.mdidea.com/products/new/new00510.html

afair there were some african arrow poisons containing the stuff, though all of those contained plenty of ouabain, so capsaicine was likely not the main active principle.

Err, BTW, sorry for bringing up a herbalism website, but that was the closest one with the LD50 values of capsaicine I was able to find on my tablet. And even if the side is, err, suspect, the numbers are close to the ones I had in mind.

@Trottelreiner,

Here is an ncbi article on various capsicum extracts and capsaicin.

The oral values are a bit lower than arsenic trisulfide or caffeine, but 2 or 3 times higher than nicotine.

But, injected LD50 values are supposed to be much lower.

http://www.ncbi.nlm.nih.gov/pubmed/17365137

@squirrelelite:
Thanks for the article. Sorry for the mistake, but to do some backpedaling, 2-3 times lower is still on the same order of magnitude, e.g. below a factor of 10. Err. ;)

Actually, I was using the numbers from

http://www.lycaeum.org/mv/mu/LD50_list.html

which listed a value of 230 mg/kg for mice orally. The same value is in my Merck Index, 12th edition. Though some other sources give an oral LD50 in mice of only 3.3 mg/kg.

As for capsaicine, I'm quoting from Neuwinger, "Afrikanische Arzneipflanzen und Jagdgifte" (transl.: "African medical plants and hunting poisons),

http://pubs.acs.org/doi/pdf/10.1021/bk-2009-1021.ch001

which gives the following toxicities in mg/kg in mice (solution in DMSO):

intravenous: 0.56
intratracheal: 1.60
intraperitoneal: 7.65
intramuscular: 7.80
subcutan: 9.00
intragastral: 190
intragastral: >218
dermal: >512

Let's stop for an "eek" and some rememberance for the poor mice. The reference is to this article:

http://www.ncbi.nlm.nih.gov/pubmed/7394809

As for nicotine, the same book is giving those values in mg/kg for mice

intravenous: 0.5
subcutan: 30
intramuscular: 8
intraperitoneal: 10
oral: 30

and rats:

intravenous: 3
subcutan: 40
intramuscular: 15
intraperitoneal: 20
oral: 190

references are to "Ryall, R.W., Nicotine in Neuroposions[sic],2,61-97"

tl;dr, there seems to be some variability in the dosages in the literature, but I still think the dosages for capsaicine and nicotine are somewhat similar. Which is not that troubling for oral dosages (where is my tabasco, BTW?), but for parenteral application, quite so. Sorry for the excursion...

It's OK, Trottelreiner.

It's a lower range of uncertainty than the Sandia chili pepper I put my guacamole yesterday for National Spicy Guacamole Day!

Those range from 500-2500 on the Scoville scale for capsaicin. My subjective estimate for my sample would be about 1500, medium but not ultra-hot.

And the guacamole was good, especially with chicken fajitas!

@squirrelelite:
One word: Mjam! And given that pure capsaicin has a Scovile of about 16,000,000

http://en.wikipedia.org/wiki/Scoville_scale

even the top value of 2500 would only be about 0.15 mg/g capsaicine, if I'm interpreting Scoville values right. So as long as you're not in the habit of eating kilograms of the stuff, leave some to your fellow commentariat... ;)

Quackademic medicine marches on: George Washington University and the University of Toronto

oracknows — Thu, 09 Oct 2014 01:00:46 +0000

Quackademic medicine marches on: George Washington University and the University of Toronto

Quackery has been steadily infiltrating academic medicine for at least two decades now in the form of what was once called “complementary and alternative medicine” but is now more commonly referred to as “integrative medicine.” Of course, as I’ve written many times before, what “integrative medicine” really means is the “integration” of quackery with science- and evidence-based medicine, to the detriment of SBM. As my good bud Mark Crislip once put it, “integrating” cow pie with apple pie does not improve the apple pie. Yet that is what’s going on in medical academia these days—with a vengeance. It’s a phenomenon that I like to call quackademic medicine, something that’s fast turning medical academia into medical quackademia. It is not, as its proponents claim, the “best of both worlds.”

In fact, it was my two recent publications bemoaning the infiltration of quackademic medicine into medical academia, one in Nature Reviews Cancer and one with Steve Novella in Trends in Molecular Medicine, that got me thinking again about this phenomenon. Actually, it was more my learning of yet another step deeper into quackademia by a once well-respected academic medical institution, occurring so soon after having just published two articles bemoaning that very tendency, that served as a harsh reminder of just what we’re up against. You might remember that a few months ago I noted the infiltration of a naturopath practicing traditional Chinese medicine at the once-respected Cleveland Clinic Foundation (CCF) and then just a couple of weeks ago I was alarmed at the CCF’s seemingly one-upping itself in quackery by starting a partnership with the guru of the quackery known as “functional medicine,” Mark Hyman. This was, sadly, not surprising, given the CCF’s history of integrating cow pie with apple pie, so to speak, in its “integrative pediatrics” program.

Yes, just when I thought things can’t get worse, they do. There is also room for hope in that I also found evidence that our criticisms are at least starting to be noticed.

George Washington University does the CCF one better

From my vantage point it’s depressingly true that the CCF has gotten very, very bad indeed with respect to its promotion of medical pseudoscience. Besides its traditional Chinese medicine clinic and its Center for Functional Medicine, just take a look at its Center for Integrative Medicine, which offers chiropractic, acupuncture, and the magical faith healing that is reiki. If you really want to see how far gone the CCF is, just read its Reiki Factsheet.)

Then look at the Center for Integrative Medicine at the George Washington University Medical Center (GWCIM). Compared to the GWCIM, the CCF’s integrative medicine program looks like a bastion of science-based medicine. GWCIM's list of services includes acupuncture (of course!), chiropractic, craniosacral therapy, infrared light therapies, glutathione infusions, Myers’ Cocktail, naturopathy (again, of course!), reiki, intravenous high dose vitamin C, and genetic profile results that include “customized interpretation of 23andme.com genetic profile results with specific accent on methylation and detoxification profiles.” It’s a truly horrifying website to contemplate, given how little of it has any resemblance to science-based medicine and how much of it includes outright quackery like reiki. Perhaps even the GWCIM is a bit embarrassed, because it can’t even provide a correct description of reiki:

Reiki describes both a harmonizing energy and a non-invasive therapy which involves the placing of hands in a sequence of locations on or near the body. It is not massage, as the hands remain stationary at each position.

The purpose of Reiki is to promote the client’s own natural healing process by providing deep relaxation, abatement of signs or symptoms of distress, or instilling a sense of harmony and balance. Reiki can be used in conjunction with any other treatment to enhance and accelerate its effectiveness.

No, reiki is faith healing that substitutes Eastern mystical beliefs for Christian beliefs, as I like to point out any time a discussion of reiki comes up. At least the CCF describes the magic that is the channeling of “healing energy” from the “universal source” more or less correctly.

I perused what GWCIM writes about a few other modalities, and its website’s descriptions of various alternative medicine modalities are depressingly and similarly credulous. Acupuncture is described as being used for “for treatment of respiratory, digestive, urinary and reproductive systems, as well as the disorders of muscle tone, hormone production, circulation, and allergic responses” plus “pain relief, gynecological conditions and symptoms, insomnia, anxiety, and to enhance wellness.” Naturopathy is described as a “comprehensive approach to health and healing that combines modern scientific knowledge with traditional and natural forms of medicine,” with naturopaths addressing “the mental, emotional and physical aspects of an individual, and aim to treat the root causes as well as the symptoms of illness.” According to GWCIM, naturopaths are “trained as primary care doctors at accredited four-year naturopathic medical schools.” They are not. Their training is inadequate and usually consists of as little as 20 days of primary care practice during their third or fourth years of naturopathy school. Meanwhile naturopaths embrace the four humors and tend to be staunchly antivaccine with rare “sort of” exceptions. Doesn’t GWCIM know that? Or doesn’t it care? Apparently not.

Indeed, look at what GWCIM says about high dose intravenous vitamin C therapy for cancer. After citing in vitro and animal studies that are not particularly compelling and then claiming that there are “several case reports published in peer-reviewed medical journals that meet quality standards set by the National Cancer Institute” that “demonstrate that a small number of patients have responded to a high dose IV Vit-C infusion treatment after all other treatments have failed” (which is patently incorrect, as these cases are as unconvincing as Stanislaw Burzynski cases), all the while admitting that there aren’t any compelling randomized clinical trials, GWCIM writes that in practice:

Based on a vast pool of clinical experience, IV administration of high dose Vit-C has been shown to essentially have no side effects, unlike chemotherapy drugs and radiation therapy. Since IV Vit-C works just like chemotherapy and radiation therapy by releasing free radicals, there are no contraindications for their simultaneous use. In fact, Vit-C may work synergistically with chemotherapy and potentiate its effect.

However, there are some disadvantages. The course of therapy is long and intense, two to three times per week (2 hours each) and for the duration of about a year. It can cost over $20,000 for a year-long course of treatment if it is not covered by an insurance.

When evaluating new innovative cancer treatments we need to ensure that three basic requirements are met:

One: There is a clinical plausibility, i.e., credible case reports exist.

Two: There is a biological plausibility, i.e., the mechanism of action is clear.

Three: Proven clinical effectiveness, i.e., a randomized controlled trial has been conducted.

High dose IV Vit-C therapy has met the first two requirements. It is unfortunate that it would take many years before the last step can be accomplished.

We feel compelled to offer this treatment to patients when there are no other choices even though the definitive clinical evidence of its effectiveness is not yet available.

Clinical plausibility? Intravenous vitamin C might not be homeopathy-grade implausible, but it’s not particularly plausible either. As I like to say frequently, vitamin C, even if it worked, would be a really long run for a short slide, given the incredibly high concentration of ascorbate that’s ever been shown to have in vitro anticancer activity. If vitamin C were anything other than “natural,” doctors would have abandoned it a very long time ago as far more trouble than its minimal to nonexistent promise warrants. Achieving such concentrations is difficult, and it is not without side effects, contrary to GWCIM’s claims. I therefore call nonsense on number one. As for biological plausibility, the mechanism is anything but clear. It could be generation of free radicals, but there are also studies suggesting that ascorbate could interfere with chemotherapy, as the Memorial Sloan-Kettering Cancer Center integrative medicine web page acknowledges as it says that high dose vitamin C shouldn’t be used outside of a clinical trial. I call nonsense on number two. Finally, while it’s true that there hasn’t been a large randomized clinical trial for vitamin C for cancer, there has been a phase I/II clinical trial that was basically negative, as I described earlier this year. So I call nonsense on number three as well.

In other words, there is no reason for oncologists at GWCIM to “feel compelled” to offer this treatment, especially given that GWCIM admits that there is no definitive clinical evidence of its effectiveness, particularly considering that, contrary to what GWCIM claims, high dose ascorbate is not without the potential for adverse events. None of this stops GWCIM from recommending high dose vitamin C for the treatment of “a variety of infections as an adjunctive modality.” I fear that GWCIM interprets the science of alternative medicines in the same way it interprets the evidence on vitamin C as a cancer treatment: Through wishful thinking and the most positive spin possible on a body of evidence that does not support their efficacy. Oh, and you can detox, possibly get chelation therapy, and help study reiki at GWCIM, too!

See why I’m depressed? Unfortunately, I’m not done yet.

Et tu, University of Toronto?

I just received an e-mail from a reader yesterday that told the sad tale of yet another domino falling. This time, it’s the University of Toronto. As you might recall, I’ve mentioned UT before on this blog, for example, an autism quackfest held there that UT ultimately disavowed when notified of its true nature. That didn’t stop UT, unfortunately, from having a real quackfest of its own, complete with presentations from a naturopath and homeopath. Yes, the Trojan horse that is quackademic medicine has arrived big time at UT.

And now, apparently, it’s there to stay:

This is why a new academic partnership has formed among our Faculty of Medicine, the Leslie Dan Faculty of Pharmacy and The Scarborough Hospital — a long time community-affiliate of the University of Toronto. The Centre for Integrative Medicine (CIM) will focus on CAM research and education. This will be achieved through an interprofessional approach — led by the Centre’s Director, Professor Lynda Balneaves — that brings together scientists, physicians, pharmacists, nurses, CAM practitioners and others who work in the health care field. Our Faculties of Pharmacy and Medicine will support the scientific research that will ground the Centre’s evidence-based approach, while a Clinical Hub will be established at The Scarborough Hospital’s Birchmount campus to help patients manage their day-to-day health. The result will be a living laboratory that allows us to study ways to safely and effectively integrate evidence-informed CAM therapies, including traditional Chinese medicine, with conventional medical care.

On September 29, our Faculty Council approved CIM’s creation as an EDU-C and on October 17, we will celebrate the official launch of the Centre. Professor Balneaves, working with colleagues across U of T and The Scarborough Hospital, has already been overseeing the first phase of the Centre’s launch, which is focused on consulting and identifying the needs of the community. She is also laying strong foundations for the effective clinical care and research to follow. By spring 2015, the Centre will launch a series of pilot projects designed to address the clinical needs of the TSH community integrated with education and applied clinical research, and it will be ready to announce long-term plans.

“Integrating” traditional Chinese medicine quackery at a new Centre for Integrative Medicine (CIM)? Lovely. Another one bites the dust, although, to be honest, UT was well on its way to becoming a center of quackademia before it announced this.

Integrative medicine advocates strike back

Three years ago, I wrote a post in which I characterized integrative medicine as a “brand, not a specialty.” In it, I described how in the 1990s “alternative medicine” was rebranded as “complementary and alternative medicine” (CAM) and, over the last few years, has been further rebranded as “integrative medicine,” which is frequently portrayed by advocates as the “best of both worlds.” It’s not that kind of “best of both worlds,” but rather this kind, with integrative medicine “assimilating” what should be—and usually is—science-based medicine, such as nutrition, exercise, and natural products into itself and fusing it with a purpose inimical to science-based medicine.

Glenn Sabin apparently doesn’t like such arguments. And, to be fair, there could be counterarguments based on sound reasoning and evidence. Unfortunately, Sabin appears incapable of offering them. Instead, he proclaims that there are “dwindling skeptics,” using what I like to call the logical fallacy known as the bandwagon fallacy. It’s a fallacy Sabin embraces with gusto:

This phenomenon is fueled by growing patient demand and an emerging cadre of integrative-trained clinicians. Patients across the spectrum of conditions and pathologies consistently experience quality outcomes vis-à-vis these services delivered by a wide range of licensed integrative health disciplines.

I like to respond to this sort of argument thusly: You know what else and who else were enormously popular? Yep, Nazi-ism and Hitler. No, I’m not claiming that integrative medicine is in any way like Nazi-ism. It is simply a suitably and intentionally overblown comparison designed to demonstrate the ridiculousness of appeals to popularity like Sabin’s as an argument. Just because something is popular does not mean it is evidence-based or good. It might be, but it also very well might not be. To take another example, half the people in the US do not believe in evolution. Does that mean evolution is not valid science? Of course not. All an appeal to popularity means is that something is popular, and often that popularity in such appeals is exaggerated.

As happy as Sabin is about the seeming “popularity” of integrative medicine, he’s equally ticked off about criticisms that it’s nothing more than a “rebranding” of quackery:

These skeptics darkly describe a continuous ‘rebranding’ of the field: from alternative medicine, to complementary alternative medicine (CAM) to the integrative health and medicine field of today. It’s not a rebranding. It’s an evolution. Some view it more like a revolution. This is about patient-centered health creation and self-efficacy. It’s the natural progression towards greater population health.

That’s right! New Coke wasn’t a rebranding! It was an evolution! Actually, the rationale for recent proposal by that the National Center for Complementary and Alternative Medicine (NCCAM) be renamed the “National Center for Research on Complementary and Integrative Health” sure sounds like a rebranding:

We see the growth of integrative health care within communities across the US, including hospitals, hospices, and military health facilities. With these changes in the research and practice landscape, we believe that our current name no longer accurately reflects our Congressional mandate, which is, in part, to study the integration of these practices as a complement to conventional care.

We also recognize that our current name is not explicit about our research mission, and that it may be misconstrued as advocacy or promotion of unproven practices.

As I pointed out at the time, this is the very same rationale that’s been used since time immemorial (or at least over the last 30 years or so that has seen the rise of CAM and quackademic medicine) every time a name change for “alternative” medicine has been proposed. As I’ve The reason for this continual rebranding of quackery is that words have power.

Sabin is also off base when he writes:

Naysayers declare that nutrition and exercise are neither “alternative” nor “integrative”; that they’ve always been part and parcel of “plain medicine”; that integrative and lifestyle medicine physicians are “coopting conventional medicine!” The truth is that a mere fifty years ago our food was largely unadulterated, grown in fertile soil and much more nutritious. People were generally more active and doctors were teachers (”teacher” actually comes from the Latin word for doctor”). Unfortunately “the teaching” aspect is largely missing today and nutrition, exercise and psycho-social counseling play no central role in the practice of conventional medicine.

Food fifty years ago was unadulterated? What about the concerns about pollution and pesticide use back then that led, in part, to the dawn of the environmental movement and stricter laws and regulations? Wonder Bread was more nutritious? Nutrition, exercise, and psycho-social counseling play “no central role in the practice of conventional medicine”? Whatever Sabin is smoking, I’d want some were it not that I can’t inhale. If psychosocial counseling plays “no central role” in, for instance, oncology, then why is it that the American College of Surgeons Commission on Cancer’s (ACS CoC’s) requirements for cancer program certification now include standards for psychosocial distress screening, survivorship care plans including addressing patients’ psychosocial needs, risk assessment, nutrition services, and physical activity and weight loss programs? Why does the ACS CoC also require education programs regarding cancer awareness and prevention to meet the needs of the community? Why is it, as I mentioned in my NRC paper, that the standard of care for prediabetes and recently diagnosed type II diabetes includes dietary interventions and encouragement of exercise? Sabin is just plain incorrect.

I can’t help but wonder if at some level Sabin knows that we “skeptics” (or, as he calls us, “cynics”) have a point, given that he writes this about us:

Perhaps they’ll refocus their energies on the real perpetuators of medical quackery: those unprincipled charlatans who often rob their patients of life and treasure with ineffective or dangerous products, agents, interventions or ideology in lieu of proven curative and often life-saving standard of care interventions.

One wonders if he means Stanislaw Burzynski. Or perhaps he means treatments like Nicholas Gonzalez’s treatments. Probably not. He does, however, castigate us for this:

I would like to see better attention paid to the contraindications between natural and formulated pharma agents, or a deeper scientific dive into the controversy surrounding antioxidant adjuvant chemotherapy and radiation therapy, and, um, less on whether acupuncture works or if Reiki’s really helpful with reducing stress and anxiety. Clearly, if patients benefit and there are no significant safety concerns, who really cares exactly how they work? (I’m not implying that scientists should stop investigating these matters. I’m emphasizing the primacy of favorable patient outcomes.)

One wonders whether Sabin doesn’t want us paying so much attention to reiki and acupuncture because, deep in his heart, he knows almost as well as skeptics do that they are quackery based on prescientific mystical belief systems. Unfortunately, as has been pointed out in other discussions of reiki quackery at the CCF, University of Arizona, and elsewhere, acupuncture and reiki are some of the most commonly offered alternative medical modality in quackademic medicine. Notice how he also seems to be admitting that these modalities are placebo modalities, asking “ Just because some health creation programs, processes and interventions (especially those based on whole systems) do not perfectly align with the traditional random controlled, double-blinded pharma model of reductionist scientific discovery, does it cancel out the patient’s positive outcome?”

The problem is that the positive outcomes touted have not been demonstrated to be due to these modalities, and, as Steve Novella, Harriet Hall, Mark Crislip, and I have discussed repeatedly, placebo effects are subjective effects, require deception, and are simply being “rebranded” as “self-healing” and the “power of positive thinking.” It’s a narrative being sold by people like Sabin.

Finally, I can’t help but note that Sabin himself has admitted that the name “integrative medicine” is a “rebranding of CAM in an article entitled CAM Is Dead:

Today several integrative centers across the country still contain the words CAM in their name. This is both confusing to health consumers and damaging for these centers’ brand. Most clinics and centers launched during the last decade have evolved with their branding to include today’s more appropriate terminology of “integrative medicine”, “integrative services” or “integrative therapies”.

The bold text is Sabin’s not mine. As I pointed out at the time, Sabin basically admitted that the term “integrative medicine” is about the marketing of quackery. This is not surprising, given that Sabin is the founder of FON Therapeutics, a company that exists for this purpose:

FON is dedicated to positioning integrative health organizations for long term growth while advancing evidence-based integrative medicine as the standard of care.

A leading business development consulting firm, FON specializes in customized solutions—focused on growing patient volume, program and product sales—driven by innovative marketing, messaging and branded storytelling, all rooted in fiscally viable business models that work.

FON offers an e-book by Sabin entitled Grow Your Integrative Medicine Business by Telling Bigger Stories (wow, I wonder if Sabin knows what that sounds like) and a white paper on How to Increase Clinic Utilization of Integrative Medicine Services in 60 Days, while expressing admiration for the Cancer Treatment Centers of America as the 800-pound marketing gorilla. FON is a marketing company, offering all sorts of marketing services to integrative medical centers, pointing out the economic potential of integrative medicine as being projected to reach $50 billion annually. Indeed, in Weeks’ article on the Hyman-CCF partnership, Sabin worries:

Sabin then raised some questions about the intersection of typical functional medicine business practices with the Cleveland Clinic culture. He noted that in Hyman’s private clinic an office visit with the doctor to the Clintons can run pretty steep. It’s $1,500 for 80 minutes with Hyman. Fifty minutes with a nutritionist will set you back $240. Hyman’s clinic does not accept insurance. Hyman’s business model also includes profiting from supplement sales, from which he donates a portion for functional medicine research.

Sabin adds a further question: “How deep will Cleveland Clinic go in terms of embracing a model of comprehensive functional labs looking at biochemical milieu to inform recommendations of well-placed nutraceuticals.” Such lab work-ups can also be quite expensive for patients even as are the bags of natural medicines that are typically part of functional medicine therapeutic regimes.

Although ideology and a misguided view that to become more “holistic” one must embrace quackery seem to be driving the infiltration of quackery into medical academia, we must never forget that there is a clever and sophisticated marketing campaign behind it as well. Does anyone think that the CCF would have embraced Mark Hyman if it didn’t think he can make the hospital significant money? I doubt it, Mark Hyman’s anecdote about how he told the CCF’s Cosgrove that it “probably didn’t want him there” notwithstanding, and I bet Sabin would agree with this point at least.

As much as advocates claim that it’s not just about the money, it’s also about the money.

oracknows Wed, 10/08/2014 - 21:00

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http://www.sciencebasedmedicine.org/astrology-alchemyesp-and-reiki-one-…

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Education

IV administration of high dose Vit-C has been shown to essentially have no side effects, unlike chemotherapy drugs and radiation therapy. Since IV Vit-C works just like chemotherapy and radiation therapy by releasing free radicals,

First, it's a bit of a broad brush to equate all chemotherapy drugs with oxidizers. Actually, I'm slightly sure a good number of chemo drugs don't work this way.

I'm also questioning how things generating free radicals in enough quantities to kill cancer cells could have plenty of side effects if they are called drugs, but none if they are called vitamins.
Chemistry is not magic. The same cause will have the same consequences.

The truth is that a mere fifty years ago our food was largely unadulterated, grown in fertile soil and much more nutritious. People were generally more active [...] nutrition, exercise and psycho-social counseling play no central role in the practice of conventional medicine.

And children were more respectful of their elders, yadda yadda.
Golden age fallacy at its finest.

A mere sixty years ago doctors were teachers who were frequently pictured in advertising endorsing cigarettes. Yeah! The good old days!

As Orac says, "words have power." However, methinks Orac misses some things about how this power works.

Quacks would not be rebranding themselves but for the exercise of power on their 'old' names. The terms of those names have become delegitimized one after the other, forcing the move to new rubrics. Alternative medicine --> CAM--> integrative medicine--> functional medicine. These 'rebrandings' would not have occurred in the absence of effective critique of the terms of the older brands.

Now, you can look at this in a couple different ways. Orac seems to see an ever more insidious move towards legitimation of unchanging practices. But there is evidence the practices are changing to keep up with their brandings. 'Alternative medicine" could be anything it damn pleased. But if you call your thing 'Intergrative medicine' you have to face demands that it integrate. if you call your thing 'Functional medicine' you have to face demands that it function.

All in all, the GWIC site scares the bejeebers out of me. But I disagree with Orac on GWIC’s description of Reiki as ‘promoting the natural healing process by providing deep relaxation, abatement of symptoms of distress, or instilling a sense of harmony and balance.’ Orac says, “No, reiki is faith healing.” I say, no Orac, reiki is just hand waving. Dominant understandings of any practice change over time. GWIC is redefining Reiki as NOT faith healing, NOT a magic channeling of healing energy from the universal source. That’s a Good Thing. If enough Influential Forces hopped onto that definitional bandwagon, the Reiki Masters could get their mystical claims chopped off at the knees.

It’s a step closer to Reiki being broadly understood as ‘one available method of relaxation therapy that might or might not work for you as pain management or stress reduction’ which makes no supernatural claims about hand-waving, and may even morph into something that doesn’t involve hand-waving at all — perhaps having the patient lie down as the sound of wind chimes play, while slo-motion cat anime plays on an overhead screen…:-)

In short, the quacks have been forced to adopt words that have the power to limit their potential harm. Can the more outrageous claims of chiro and acu hold up under the rubric of 'functional medicine' under the umbrella of real hospitals? Or will these 'modalities' be reined in to the mostly placebo effect stuff most people use them for anyway? Or rather, do the words they've now adopted have the power to be harnessed in critique of the dangerous claims, and to force the pseudo-science treatments into narrower frames that will deligitmate those practitioners outside the 'quackademic' hospitals still claiming chiro or acu or Reiki can cure actual diseases?

Wow. The value of a GW degree is falling before my eyes.

All in all, the GWIC site scares the bejeebers out of me. But I disagree with Orac on GWIC’s description of Reiki as ‘promoting the natural healing process by providing deep relaxation, abatement of symptoms of distress, or instilling a sense of harmony and balance.’ Orac says, “No, reiki is faith healing.” I say, no Orac, reiki is just hand waving. Dominant understandings of any practice change over time. GWIC is redefining Reiki as NOT faith healing, NOT a magic channeling of healing energy from the universal source. That’s a Good Thing. If enough Influential Forces hopped onto that definitional bandwagon, the Reiki Masters could get their mystical claims chopped off at the knees.

Bullshit. Reiki masters still refer to all the mystical mumbo-jumbo. It's what they believe. It's what reiki is. Academic hospitals such as the Cleveland Clinic, the University of Arizona, and many others still invoke the mystical, magical "channeling of healing energy" nonsense. Don't believe me? Check out the links below.

http://www.sciencebasedmedicine.org/reiki-fraudulent-misrepresentation/

http://scienceblogs.com/insolence/2014/03/27/quackademic-medicine-at-an…

GWU is merely excising that nonsense from its promotional materials on its website, likely to disguise the quackery that it is.

A mere sixty years ago doctors were teachers who were frequently pictured [sic] in advertising endorsing cigarettes.

For this I switched off the Plonk-O-Matic?

This phenomenon is fueled by growing patient demand and an emerging cadre of integrative-trained clinicians. Patients across the spectrum of conditions and pathologies consistently experience quality outcomes vis-à-vis these services delivered by a wide range of licensed integrative health disciplines.

A large part of the reason for this "growing patient demand" is the propaganda from promoters of quackademic medicine. It has been shown that if statements are repeated often enough in mass media, many people will believe those statements, whether or not they are true. You know who pioneered that technique, right?

Also, I don't think "quality outcomes" means what Sabin thinks it means.

Et tu, University of Toronto?

Just another reason why the *ROC hates Toronto.

*Rest of Canada

Note reiki being described as " the placing of hands" and
" the hands remain stationary"-
( also "harmonizing energy" and "non-invasive therapy")

apparently contrived to entirely circumvent the expression:
* laying on of hands* which sounds too biblical.

Also: "a mere fifty years ago, our food was unadulterated, grown in fertile soil and much more nutritious."

Hah! It seems that they have adjusted the partyline ( I am much more familiar with woo-meisters saying '100 years' or the 'turn of the 20th century') which isn't terribly bright of them because many potential customers can recall what they ate 50 years ago
HOWEVER it may perhaps stoke the fires of nostalgia for home-cooked meals, whole grain oven-baked breads and steaming cherry pies created by mothers and grandmothers in days of yore.
Which probably didn't exist across the board-
well alright, it didn't in my families which enjoyed packaged, frozen, canned/ tinned goods and whatever restaurants had to offer. They were ahead of their time.

HOWEVER it may perhaps stoke the fires of nostalgia for home-cooked meals, whole grain oven-baked breads and steaming cherry pies created by mothers and grandmothers in days of yore.

Nostalgia ain't what it used to be.

The 1950s and early 1960s were very much the era of Wonder Bread. Whole wheat bread existed, but its use by middle-class white families did not gain general acceptance until the 1970s. Flour was generally white flour; I don't recall when whole wheat flour became available in ordinary grocery stores.

I happen to own a cookbook that was published in 1963. The authors of this cookbook seem not to have heard of olive oil. Italian and "Chinese" (the latter being heavily Americanized; I didn't eat real Chinese food until I went away to college in a city with a substantial Chinese population) cuisines were considered edgy. Tea meant Lipton, which Douglas Adams so aptly described as "a substance almost but not quite entirely unlike tea." No, I do not want to go back to that era in US culinary history.

"dwindling skeptics"
A closer analogy would be the creationists' claim that the theory of evolution has been disproved and the whole house of cards is about to fall. Of course they have been saying that for about 100 years...

Also, 60 years ago Johnny couldn't read and comic books were the cause of juvenile delinquency.

A mere sixty years ago doctors were teachers who were frequently pictured in advertising endorsing cigarettes. Yeah! The good old days!

Is that true? The British Doctor's Study that provided convincing evidence of a link between smoking tobacco and lung cancer was published in 1956. I thought the 'doctors' featured in cigarette advertisements were actors, like the Marlboro cowboys (though some of them really were cowboys, apparently). I have seen the "more doctors smoke Camels" advertisements, but they seem to me to simply show that doctors can get addicted to tobacco just like mere mortals, rather than being a medical endorsement of smoking.

Just another reason why the *ROC hates Toronto.

To be fair, while Toronto is hated, I never get the feeling that U of T is even disliked. I say this as an alum. Now Queen's on the other hand...

@ Eric Lund:

Right. They want to have it both ways: for it to be far enough back in time so that there isn't a clear memory but close enough so that living people can 'remember' how wonderful food was-
only that like much in the altie repetoire, this meme is concocted of whole cloth, folk tales and clever language in order to lead their thralls where they would have them go: the miraculous but fabulous** past.

Interestingly enough, the TMs and their kin @ AoA, most of whom range in age from 40-60 years, write about how commercial food products have deteriorated when comparing what they grew up with and what is available now. They carry on about how food ( and vaccines) lead to chroniic illness and ASDs in children - as a matter of fact, TMR currently has an e-conference available that focuses upon GMOs and other dastardly plots by the food industry's corporate criminals who are in league with the corporate criminals in pharma etc.

Similarly, PRN and NN spin tales about today's bad food as if most people truly exist on fast food and candy bars.

** in the original sense, as in fabled.

I always like hearing about these schools offering "Traditional Chinese Medicine" especially when, having lived in China, the Chinese don't really even trust it. When given the option, they always head to a real hospital for real treatment.

"This phenomenon is fueled by growing patient demand and an emerging cadre of integrative-trained clinicians."

Yeah, every 30 years like clockwork, a cadre of integrative-trained clinicians emerges from the ground, chews the leaves off the trees, mates and disappears underground again for 30 more years.

Trouble is, they're resistant to most sprays.

I always like hearing about these schools offering “Traditional Chinese Medicine” especially when, having lived in China, the Chinese don’t really even trust it. When given the option, they always head to a real hospital for real treatment.

Indeed. Just last weekend, a friend of mine upon hearing that my father was diagnosed with AML a few months ago but is doing very well, now, chirped up with "Did he try Eastern medicine?"

Whereupon I said - a little more sharply than I intended - "No, he decided to use medicine that ACTUALLY WORKS."

Given how much I've been biting my tongue around some folks (If I hear "Gerson therapy" one. more. time.) I think a blowup was overdue.

(The stem cell transplant has settled in nicely and is apparently kicking all the *ss that needs to be kicked. Yay, science!)

Accounts of Chinese traditional medicine started reaching Europe in the 17th Cent. William Wotton, in his "Reflections on Learning....." (1694) reported on it thusly:
"....the Missionary who sent this account ....was afraid it would be thought ridiculous .......which fear of his seems to have been well grounded."
"It would be tedious to dwell any longer upon such Notions as these, ....The Anatomical Figures ...are so very whimsical, that a Man would almost believe the whole to be a banter..."

Wotton, an early manifestation of a skeptic maybe, was a very fair-minded man, and went on to allow that perhaps some Chinese herbal remedies might be efficacious. But I think in the 300 years since he wrote precious little has panned out.

I always like hearing about these schools offering “Traditional Chinese Medicine” especially when, having lived in China, the Chinese don’t really even trust it.

As Orac noted about a year ago, one of the biggest popularizers of so-called traditional Chinese medicine was Mao Zedong himself. He had reasons, specifically that there were not enough doctors in China at the time (early 1950s) who were trained in Western medicine. But Mao always insisted on Western medicine for himself, as he found Chinese medicine implausible.

The quick study of the Chinese language I made before visiting Beijing included a mention of the distinction between Chinese (zhong) and Western (xi) medicine, and how to request the latter if needed (luckily, I never needed to use any of the phrases in that section of the book).

Apparently, the GW CIM recently hired a new Physician Assistant named Rosina Cabo who will be prescribing bio-identical hormone therapy, nutrition, and supplements.

Also, we learn that the GW CIM is involved in an assortment of quackademic research, including the infamous TACT trial.

TBruce @7 " Just another reason why the *ROC hates Toronto"

Did not know another reason was needed, but as a long term lurker, somehow remember you are out West so: at the University of Alberta ( http://www.care.ualberta.ca/ )

"Healthier children through evidence-based integrative health care.

Complementary and Alternative Research and Education (CARE), launched in 2003 at the Department of Pediatrics at the University of Alberta, is Canada’s first academic pediatric integrative medicine program. Its mission is to generate and disseminate evidence about pediatric complementary and alternative medicine (CAM), to ensure safe and informed use. A clinical assessment program was added in 2006..................." Is further downhill from there.

Although I am not aware of any formal programmes at the University of British Columbia, they are well on their way with a Society on campus; AIMS ( http://www.aims.ubc.ca/ )

Dave Ruddell @12 " never get the feeling that U of T is even disliked. I say this as an alum. Now Queen’s on the other hand…"

Agree for U of T once one gets past the hog smell. Even Michael Ignatieff had to move back to Boston. Queen's is much more refreshing for a better learning experience.

The public demands these alt med treatments and practitioners because they're fed up with getting 5 minutes with their overwhelmed physicians who no longer have time to develop rapport or a meaningful relationship with their patients.

Since alt med practitioners as a whole cannot (yet) bill insurance for their services, they can charge what the market will bear and spend a whole lot more time listening and pontificating, which results in patients feeling heard and validated. These practitioners tend to have more time to address lifestyle and diet, among other things, however usually end up making overblown claims, recommending wacky, restrictive diets, and prescribing dietary supplements. GAH! This is the mess I often have to clean up. Alkaline diet anyone? Juice Plus? A smorgasbord of herbs? High dose antioxidant therapy? The list goes on and on...

I suspect that patients of concierge or direct pay practices are far more satisfied with their evidence-based medicine than the rest of us. I don't blame the doctors a bit, it's the very broken system that has resulted in creating the market for quack medicine.

The truth is that a mere fifty years ago our food was largely unadulterated,

Think how much purer it must have been one hundred years ago!

Think how much purer it must have been one hundred years ago!

Back then they only used natural non-toxic agricultural chemicals like lead arsenate, whereas 50 years ago they were using organic DDT. These days deadly chemicals like glyphosate are in common use. /sarcasm

Alberta is to Canada as Texas is to the United States. Interesting, and not in a good way, that this analogy holds for alt-med as well as politics and economics.

http://lileks.com/institute/gallery/ for more examples of the oh so much healthier food of the 30s to 60s-ish—NOT!

Since alt med practitioners as a whole cannot (yet) bill insurance for their services, they can charge what the market will bear and spend a whole lot more time listening and pontificating, which results in patients feeling heard and validated.

If the choice is really between receiving treatment which has actually been shown to be safe and effective and instead being heard and validated while receiving treatments that have either not been shown to be safe or have actually been shown not to be safe and effective, to paraphrase Richard Pryor "I don't know about you but I'm gonna be in the long line".

Kreb:

A mere sixty years ago doctors were teachers who were frequently pictured in advertising endorsing cigarettes. Yeah! The good old days!

That was mean as Sabin-smack, not doctor-smack. Just another indication that the imagined wonderful 'natural' past Sabin conjectures was neither so wonderful or natural.

The most prominent docs&cigs campaign was "Three National Surveys Prove ore Doctors Smoke Camels Than Any Other Cigarette". You can see the history of cig ads at this Stanford Med School site: http://tobacco.stanford.edu/tobacco_main/main.php

Some copy from that site:

One common technique used by the tobacco industry to reassure a worried public was to incorporate images of physicians in their ads. The none-too-subtle message was that if the doctor, with all of his expertise, chose to smoke a particular brand, then it must be safe. Unlike with celebrity and athlete endorsers, the doctors depicted were never specific individuals, because physicians who engaged in advertising would risk losing their license. (It was contrary to accepted medical ethics at the time for doctors to advertise.) Instead, the images always presented an idealized physician - wise, noble, and caring - who enthusiastically partook of the smoking habit. All of the "doctors" in these ads came out of central casting.. Little protest was heard from the medical community or organized medicine, perhaps because the images showed the profession in a highly favorable light. This genre of ads regularly appeared in medical journals such as the Journal of the American Medical Association, an organization which for decades collaborated closely with the industry.

The ads in trade pubs aimed directly at MDs are here:
http://tobacco.stanford.edu/tobacco_main/subtheme.php?token=fm_mt021.php
The first two-subcategories are "science" and "clinical trials."

In short, there's nothing new about free-market profiteers turning to pseudo-science to sell dangerous stuff; and pseudo-science always tries to co-opt real science in seeking to legitimize the sales pitch. However, this is dangerous for the scam-seller, as a backfire is always possible. After 4 decades of pushing cigarettes as Healthy with images of kindly family physicians -- when physicians finally turned on the tobacco industry after the carcinogenic effects were established -- that was Big Blow to Big Tobacco exactly because they had helped build up the Doc's public rep.

Orac:
Of course I believe you, about what your average Reiki Master claims, and that some 'legit' medical faciltiies are embracing the mumbo jumbo. That's not the point. The point is that GWIC's redefinition of Reiki opens a path to defang Reiki of its most noxious mumbo jumbo. It's just an opening, not a sign of teleology that's going to work out by itself.

Between 1880-1980 (roughly speaking) the dominant political order in the U.S. faced a series of challenges in the name of social justice, from the industrial labor movement, the women's movement, the civil rights movement, the anti-war movement. Each of these was met with brute force repression, which in every case proved ineffective. Ultimately, each of these movements was co-opted by the mainstream, and brought into the fold on terms that worked to the advantage of the powers that be. E.g. radical labor sentiment was defused by the trade-unionism of AFL, which led to de-politicized local unions that actually assisted management in maintaining order and discipline on the shop floor. For a more recent example, see Todd Gitlin's The Whole World Is Watching: Mass Media in the Making and Unmaking of the New Left. The common thread: by accomodating and incorporating the least threatening members and demands of each wave of protest, the movements become fractured, and the outsiders become more desperate, their positions amplified to meet the looney images projected by mainstream propaganda, leading ultimately to their social failure. So SDS goes from peaceful protests in the early 60s to Weather Underground bombings in the 70s and then implodes altogether.

It would be nice to see the good guys judo the bad guys just once.

Of course capitalism is 'Bullshit!" But bullshit works. :-) Though you might want to call it something else .

Yeah, every 30 years like clockwork, a cadre of integrative-trained clinicians emerges from the ground, chews the leaves off the trees, mates and disappears underground again for 30 more years.

Are you talking about Cicadids or a crop of Richard Nixons?? As far as I know, the cicadas don't eat anything after they emerge. It's one of the most beautiful cycles to me... I recount my past days and change, brood to brood (both 13 and 17 year-- those days are inscribed in me as if they were laser-etched in crystal) No doubt, people who slave away on worthless and pernicious growing of 'lawns' come along and think they need spraying... these same type people also just must have a streetlight -- They feel unsafe otherwise -- like little indoctrinated children. They have allowed themselves to be trained to just never look up as they won't see anything. And their kids all have sleep disorders and are nearsighted, as well.

--If somebody installs their own or demand it be fixed when it fails, triple bright at that, I say they're too far gone 'derps' and are dangerous to the wellbeing of all others. If it happened to be loud music then I could have them arrested. Go figure.

http://www.youtube.com/watch?v=fzv6JzpCWhI
http://www.youtube.com/watch?v=oqys8lKsu4s

I happen to own a cookbook that was published in 1963. The authors of this cookbook seem not to have heard of olive oil.

The same year that The French Chef premiered, BTW.

I’m also questioning how things generating free radicals in enough quantities to kill cancer cells could have plenty of side effects if they are called drugs, but none if they are called vitamins.

It seems to involve patting your head while rubbing your belly.

^ Because not this.

Narad,
Your first link led me to discover that apparently ayahuasca (harmine, actually) cures cancer, well it activates p53 anyway.

About 50 years ago my father's partner used to smoke while consulting his patient's at the surgery. Ah the good old days!

Funny, but not, at the same time.

RE: p53

I've been at Wikischool lots lately and considering N-acetylcysteine (NAC). But:

Because somatic mutations in p53 occur late in tumor progression, antioxidants may accelerate the growth of early tumors or precancerous lesions in high-risk populations such as smokers ... it is important to reiterate that NAC does not cause cancer, it counteracts ROS accumulation caused by p53 and down-regulates p53, which in turn prevents p53-induced apoptosis and promotes autophagy.

and

acetylcysteine was metabolized to S-nitroso-N-acetylcysteine (SNOAC), which increased blood pressure in the lungs and right ventricle of the heart (pulmonary artery hypertension) in mice treated with acetylcysteine.

and

Although N-acetylcysteine prevented liver damage when taken before alcohol, when taken 4 hours after alcohol it actually made liver damage worse in a dose-dependent fashion.

http://en.wikipedia.org/wiki/Acetylcysteine#Adverse_effects

Now, I'm guessing that some xenoprobing may be prudent to make sure there aren't any eighty-foot satellite dishes hiding up there waiting to unfold for that first part??

Annd... I've seen similar concerns over 5-htp and p-5-p and the heart (though, that's mostly from 'fibrosis' I *think*)

Annnd... Is there some commonality/mechanism between the bad outcome of NAC with alcohol and why I now get a raging hangover if a tiny bit over my 'new limit' though drinking much less with the 5-htp/melatonin/5HT workings {past hangovers were rare at 150/day -- and even at the occasional 300}? -- I've seen all the 'good' stated on 5-htp and this 'hangover' encouraging one to drink less but is this hangover indicative of enhanced damage otherwise? (Current EToH ~100ml/day. A six of 4.7s -- All Day IPA because 312 Urban Wheat was 'inconsistent' causing me to look closely at the bottle: B&B'd Baldwinsville, NY and Fort Collins, Co. with all that entails.)

Any SBM thoughts, docs? Or maybe it takes a ND?

* getting that 'sinking' feeling on a long, dark swim

When I was in Med School 40 years ago, we had several instructors that chain smoked. One would lecture on diabetes while smoking one after another for the whole hour. Another would give lab sessions, smoking till our eyes hurt. Another would do autopsies with a butt in his mouth, dropping ash into the thoracic and abdominal cavities. Considering how addictive cigarettes are, it was gratifying to find out that they had all quit smoking a few years later.

@Krebiozen #33

apparently ayahuasca (harmine, actually)

There's a tiny amount of those alkaloids in passionflower (a very weak MAOI) which I'd been incredibly fond of ingesting much these past couple of years until I was unable to tinc up my own this year.

About 50 years ago my father’s partner used to smoke while consulting his patient’s at the surgery. Ah the good old days!

My boss in the biochemistry lab 30-odd years ago smoked a pipe, and would wander around the lab with it lit, which bothered me greatly when I was doing an ether extraction, since diethyl ether is extremely flammable, and explosive when mixed with air.

I only smoked in the lab tea room back then, which seems astonishing now smoking anywhere on hospital grounds is completely banned. We often went to the hospital bar (!) for a pint or two (sometimes more) at lunchtime, and would see a certain eminent surgeon sinking a pint of Abbot Ale to steady his hand before surgery. How times have changed.

Given that so many advocates of these 'integrative' therapies seem to think the placebo effect is some mystical magical mind-body connection, it's little wonder that the focus will shift from science to advertising. If something works "because you believe it will work," then this is a marketing dream world. Clients are visualized as having invisible little "Lie To Me" placards hanging around their necks.

Indeed, when placebos are the real thing, what would it mean to 'lie?'

Bastyr's undergraduate physics requirement is curious:

1 college-level course
Course must be algebra-based; calculus-based is also accepted.

Your first link led me to discover that apparently ayahuasca (harmine, actually) cures cancer

Harmine seems to do all kinds of stuff.

@ Sastra:

Exactly. I surmise that they think placebos either liberate vital energy to do its healing work or that they're a direct link to the divine source itself.

^ #40 is of course in the wrong thread.

@Narad - I took literature courses in college that required Calculus as a prerequisite. Just sayin'.

Just need to let you know, "Orac," that you are as blind as a bat. I can't believe you are a surgeon with that type of lack of understanding. I certainly wouldn't want you operating on me. You are intellectual, sure, but somehow just lack the ability to see the big picture. My friend, you have your third eye so calcified shut that it's practically a bone. Not that you have a clue what that means. You really need to stop spreading the idea that NDs are untrained to practice medicine. Have you ever even seen the clinics used to train NDs in states such as WA? Or are you even aware that NDs complete a rigorous scientific medical education, heavy in biochemisty, anatomy and physiology, microbiology, pathology, etc., along with conventionally well-respected subjects such as nutrition and midwifery, as well as herbal chemistry and some Eastern medicine theory and technique, and complete a 2 yr residency in a clinic or in a hospital? Orac, you're a mean-spirited bully who really doesn't prove anything other than that you have a lot of ill-researched opinions. You don't back up your statements with anything other than more of your own unenlightened bias. Either I'm the only person who feels like wasting their time responding to your egotistical, negative, and highly misinformed personal blog that you deem to be the voice of "science," or you don't let anyone with an opinion differing from your own post comments on here. NDs are far from perfect, but they have a PhD, and that is something to respect in ANY field. MDs are also far from perfect and medicine in the United States has a lot of room for improvement. You think it is perfect? I work on both sides of the spectrum, my friend. I have two words for you. "Nosocomial infection." You really need to stop spreading your accusations of "quackery" before someone reports this site for outright slander.

NDs are far from perfect, but they have a PhD, and that is something to respect in ANY field.

No they don't.
And I wouldn't respect them even if they did.

@sheba

Care to point out where you feel where Orac has made mistakes?

Because it sounds like you are making blanket accusations without any proof, and it seems that he hit pretty close to the mark, judging by your remarks.

and complete a 2 yr residency in a clinic or in a hospital

Really?
I checked the licensing requirements for naturopaths in Canada, and it requires 1500 hours of clinical exposure during the 4 years (total) of training. Nothing about a 2 year residency.
MDs in Canada get much more clinical experience during their undergraduate studies for the MD, THEN they require at least 2 more years of residency training before qualifying for primary care medicine.
Also, where would a naturopath do a hospital residency? I have never seen or heard of a naturopath resident in a hospital.
The rest of your little rant appears to be similarly based in reality.

NDs are far from perfect, but they have a PhD

Evidently 'credibility' is not high on Sheba's list of priorities.

I have two words for you. “Nosocomial infection.”

Do NDs have some magical way of preventing infections from spreading in hospitals? Or is it just that they mainly deal with the worried well who don't require hospital treatment? I get irritated by those who criticize conventional medicine for [insert gripe here] when they have no effective alternative.

Narad,

Harmine seems to do all kinds of stuff.

It even makes people telepathic, when combined with LSD as 'telepathine', if memory serves (not really, of course, but that was the belief, for a while). I wonder if flying carpet tales are linked to the psychedelic effects of harmala alkaloids, since syrian rue is used as a carpet dye in the Middle East.

Mephistopholes --

I took literature courses in college that required Calculus as a prerequisite. Just sayin’.

Was it a course on Pynchon?

War and Peace also has some calculus-based philosophical speculations, if I recall.

In reading (partway) through Sheba's post (@45) I'm struck by how frequently folks in her cadre have never mastered one of the miracles of modern communications: the paragraph break.

My friend, you have your third eye so calcified shut that it’s practically a bone. Not that you have a clue what that means.

Honeybunch, you might want to be careful about blundering into places and trying to pull stunts like this while lacking a familiarity with the autdience.

^ "audience"

Oh, this is good:

You really need to stop spreading your accusations of “quackery” before someone reports this site for outright slander [sic].

Is this part of the legal training provided in the naturopathic "Ph.D." program? To whom is "someone" going to "report" it?

NDs are far from perfect, but they have a PhD, and that is something to respect in ANY field.

Amenable to disproof by counterexample, BTW.

Any NDs want to provide a detailed analysis of this?

For the past several weeks an empty store in my neighbourhood was papered over and in the throes of renovation. Finally, a banner went up announcing the imminent opening of an "organic and health food" store. I couldn't give a damn about anything organic, but sometimes these health food stores carry a decent selection of nuts, spices, flours, etc. in bulk.

I walked by this afternoon and they're open. In the window alongside the Rainforest Crisp crackers was an assortment of "detox" crap and a sign stating they had a naturopath on premises available for consultations.

I won't be going in to see if they do indeed sell anything in bulk. I refuse to patronize businesses that are supplement mills and that promote useless, if not dangerous advice from "naturopaths."

At least in my experience those health food store naturopaths limit their advice to pushing products available in the shop and don't delve into serious issues like cancer or Ebola. But who knows? Maybe some of them have private practices and encourage their health food clientele to see them for follow-up in their "clinics" for more elaborate, more expensive and more bogus "treatments." After all, it's hard to diagonose chronic lyme or adrenal dis-orders or fibromyalgia at a card table at the end of the vitamin aisle.

Was it a course on Pynchon?
I rate for "The Secret Integration".

you have your third eye so calcified shut that it’s practically a bone.
Fortunately my third nostril is in perfect working order.

Oops...I thought I was posting on the thread Sh*t naturopaths say, part 2: Naturopathic education and science.

narad - do she shamans shell she-shells?

I took literature courses in college that required Calculus as a prerequisite.

I took one philosophy class that cut to the chase and used operators, but I think that was probably an "or by instructor consent" deal, because I don't recall having seen a familiar face among the smallish class.

Quackademic medicine now reigns supreme at the Cleveland Clinic

oracknows — Tue, 23 Sep 2014 02:00:09 +0000

Quackademic medicine now reigns supreme at the Cleveland Clinic

Quackery has been steadily infiltrating academic medicine for at least two decades now in the form of what was once called “complementary and alternative medicine” but is now more commonly referred to as “integrative medicine.” Of course, as I’ve written many times before, what “integrative medicine” really means is the “integration” of quackery with science- and evidence-based medicine, to the detriment of SBM. As my good bud Mark Crislip once put it, “integrating” cow pie with apple pie does not make the apple pie better. Yet that is what’s going on in medical academia these days—witha vengeance. It’s a phenomenon that I like to call quackademic medicine, something that’s fast turning medical academia into medical quackademia. It is not, as its proponents claim, the “best of both worlds.”

Quackademic medicine has been infiltrating many formerly science-based academic medical centers. Such centers have a seemingly amazing ability to compartmentalize, insisting on rigorous science for most treatments but possessing an amazing blind spot when it comes to anything having to do with “integrative medicine.” Unfortunately, in few places is this tendency as intense as it is at the Cleveland Clinic Foundation (CCF). It’s an institution with which I have some familiarity, given that I lived in Cleveland for eight years from the late 1980s to the mid 1990s because I did my general surgery residency at Case Western Reserve University and University Hospitals of Cleveland just down the street. At least, that’s what it was called at the time. I also worked as a flight physician for Metro LifeFlight, and a frequent destination for cardiac patients that we picked up from outlying hospitals was—you guessed it—the Cleveland Clinic. Twenty years ago, the CCF was Case’s chief rival in terms of medicine, science, and competition for patients. These days, their relationship is no longer as acrimonious as it was when I was at Case, but unfortunately the two institutions appear to have become rivals in quackademic medicine.

It’s a rivalry the CCF appears to be winning. Sure, Case has a big integrative medicine program and sponsored a meeting of the Society for Integrative Oncology and has been caught recommending reflexology, but that’s nothing compared to the CCF’s promotion of “energy healing’ (in particular reiki), acupuncture for children, and, most recently, the opening of a traditional Chinese medicine clinic run by a naturopath.

So what can CCF do to top that quackery? I wish I hadn’t asked. The reason is that I just learned over the weekend that the CCF has ratcheted up the quackery to 11 and beyond. How? Simple. See this article in the Cleveland Plain Dealer:

In its ongoing focus on wellness and disease prevention, the Cleveland Clinic is opening a new Center for Functional Medicine. In doing so, the Clinic is the first academic medical center in the United States to embrace functional medicine, the focus of which is more on identifying underlying causes of illness and less on symptom management.

The center will work together with Clinic specialists to study the impact functional medicine has on certain chronic diseases.

Within the next few weeks, screening will begin for the first of up to 300 patients for one of four clinical trials comparing the standard treatment for asthma, inflammatory bowel disease, type 2 diabetes and migraines with that of functional medicine approaches.

The new center at the Clinic's main campus is a collaboration between the Clinic and The Institute for Functional Medicine. Dr. Mark Hyman, chairman of The Institute for Functional Medicine, whose offices are in Washington state and New Mexico, and founder of The UltraWellness Center in Massachusetts, will serve as director of the new Center for Functional Medicine.

That’s right. The CCF has embraced the quackery that is “functional medicine” and even hired the most famous practitioner of that quackery, Dr. Mark Hyman. We’ve met Dr. Hyman before many times on this blog. For instance, he has argued for turning back the clock and relying on anecdotal medicine instead of scientific medicine, mangled cancer research and systems biology to justify the quackery that is “functional medicine,” and twisted autism science even worse. Most recently, it’s been reported that Bill and Hillary Clinton have fallen under Dr. Hyman’s spell.

So what does this mean for CCF? Quackery. That’s what it means. Don’t believe me? Go back and read my description of functional medicine. Look at Wally Sampson’s multi-part analysis of what functional medicine is claimed to be here, here, here, here, and here. Basically, it’s a vaguely defined “discipline” in which it is claimed that measuring a whole bunch of metabolic factors and other lab values will lead to a “holistic” approach to disease. Never mind that just what “functional medicine” actually entails is kept quite vague. That vagueness is the very thing that allows Dr. Hyman to claim:

“Functional Medicine looks at the underlying causes of disease, while focusing on the whole person rather than an isolated set of symptoms,” Hyman said in the news release. “We look at a patient’s history and the personalized interactions among genetic, environmental, and lifestyle factors that can influence long-term health and complex, chronic disease.”

The new center is a collaboration with The Institute for Functional Medicine, an organization also led by Hyman.

Of course, “functional medicine” does nothing of the sort, at least not any better than conventional medicine. According to news reports, Hyman will only set foot in Cleveland three days a month, which makes me wonder how he can be the director of anything there, much less a center at a large institution like the CCF. Of course, there’s been a doctor hired to do the day-to-day grunt work of running this new center: Dr. Patrick Hanaway, was the chief medical officer of Genova Diagnostics from 2002-2012, a laboratory that offers all sorts of tests of dubious medical value, including a saliva adrenal stress profile, comprehensive diagnostic stool analysis, and toxic effects CORE, among others. Of course, Dr. Hanaway is an integrative “holistic” practitioner. After that, he apparently became the director of medical eduction for Dr. Hyman’s Institute for Functional Medicine. Frighteningly, the practice where Dr. Hanaway works offers “holistic newborn and pediatric care,” including what is characterized as “grounded discussions” on vaccines:

Each talk is facilitated by Dr. Susan Bradt or Dr. Lisa Lichtig, board certified family physicians who practice holistic medicine. We cover the hot topics of controversy including links made to autism and asthma, the ingredient thimerosal (mercury), individualizing schedules and current outbreaks of vaccine preventable disease in our community. We review each disease and its associated vaccine and discuss vaccine ingredients, school requirements and legal issues. An extensive handout is provided to supplement the class and serve as a future reference. This class is essential for all families so they can be more informed about vaccinations. It is especially helpful for parents feeling concerned or hesitant about vaccinating their children according to the standard schedule. It provides a grounded explanation of the issues and helps remove fear surrounding the topic thus helping parents navigate decision making from a more balanced and educated starting place. You will walk away with a great foundation on the topic of childhood vaccines and be able to confidently make choices that feel safe for your family.

I recognize the code words, as, I’m sure, do many of you who follow the vaccine manufactroversy from a science-based perspective. The big giveaway is that the clinic website doesn’t dismiss the “links made to autism and asthma” (hint: there are not, at least none that are evidence-based) and claims to discuss “ingredients,” a sure sign that the class involves the “toxin gambit,” a fallacious gambit designed to cause great. It's of a piece with Dr. Hanaway's boss Dr. Hyman's recent foray into anti vaccine fear mongering with Robert F. Kennedy, Jr. One wonders why the CCF would hire someone who spreads such blatant antivaccine propaganda as Dr. Hyman does.

Then there’s this:

For uncomplicated pregnancies we encourage laboring at home as long as possible with the support of a birth partner and/or doula. Once at the hospital we help create an intimate and encouraging atmosphere utilizing low lighting, freedom of movement, homeopathy, vocalization, massage, water, birthing ball and stool to support women in labor as it intensifies. Medications and epidurals are available upon request. Woman birth in a variety of positions including in the water and squatting.

Yep, Dr. Hanaway’s partners practice “natural childbirth” woo.

So how on earth was someone like Dr. Hyman or Dr. Hanaway offered a job at an institution as prestigious as the CCF? Listen to the CEO of the CCF, Dr. Toby Cosgrove. He’ll tell you:

In the release, Clinic CEO Dr. Toby Cosgrove said the new center is “not a departure for Cleveland Clinic, but a continuation of the innovative, holistic approach that we have embraced.” Cosgrove cited the Clinic’s wellness institute, Center for Integrative Medicine, its Chinese herbal therapy clinic and the Center for Personalized Healthcare.

I can’t argue with this. The CCF has been traveling down the road of quackademic medicine for a long time. This new initiative is nothing more than a continuation of the “integration” of quackery into medical practice at the CCF. There’s nothing “innovative” about its practice; it’s just embracing ancient, pre-scientific medicine on the one hand (the traditional Chinese medicine clinic) and a modern version of the same sort of thing, in which the idea seems to be to check as many lab values as possible until something is found to be wrong (as it will be with virtually everyone if you check enough lab values) and then to “treat it,” labeling the “treatment” as somehow “holistic.”

Unfortunately, I can’t argue that CCF isn’t a trailblazer. Unfortunately, it’s a trailblazer in introducing quackery into conventional medicine. Cosgrove ought to rename the CCF to the Cleveland Quackademic Clinic, as sad as it is for me to contemplate the decline of a once-great institution.

oracknows Mon, 09/22/2014 - 22:00

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Could you please explain what you mean by natural childbirth woo? What was so objectionable about that quoted content? It reads as nothing inherently dangerous and basically supportive of the birth experience, with interventions available as required. What's the issue there? (Aside from some nice placebos)

There are issues with "natural childbirth woo", when it includes immersion in water during the first stage and second stage of labor. The joint opinion of the ACOG and the AAP (April, 2014) is here:

Thanks, lilady. It doesn't read as strictly out, at least not for first stage. Perhaps if that is what is sought by mothers (and may be associated with decreased pain and anaesthesia and duration), it is better off being provided in the kind of context of this clinic. The Orac quote is framed as for 'uncomplicated pregnancies' so it does indicate screening and 'integration,' not an entirely separate pathway.

Here, Dr. Mark Hyman, who "collaborated" with Robert Kennedy Jr., who wrote a dreadful book on the dangers of vaccines, claims he is "pro vaccine". He brags about the Cleveland Clinic's adoption of his "functional medicine":

http://blogs.discovermagazine.com/collideascape/2014/08/20/robert-kenne…

Oh, my, this is bad.

I can only imagine how much more difficult it would be to, say, fight global warming denialism if earth science departments were being bribed by oil money into hiring denialist crackpots.

This shows yet again that many physicians don't understand much about science. There are, of course, many laudable exceptions -- present company included.

It looks very much as though Cleveland Clinic, through this new program will be encouraging patients to follow "individualized" vaccine schedules for their children - meaning delaying or even dropping some vaccines.

What's important is that parental decisions will "feel safe" (according to Cleveland Clinic) - not that they _are_ safe.

I know of no other major medical facility that's promoting such a thing.

@Eliot

The idea of 'if people are going to use quackery, isn't it better that they use it under proper medical care?' is one of the ways that quackery creeps into real medicine. Because no one says 'the following techniques are utter bullshit and potentially dangerous, but you can do them here if you really insist'. They dress quackery up with the kind of fluffy language that Orac quotes, and by positioning it next to real medicine they legitimize it in the view of patients who trust their doctors to tell them what works and what doesn't.

Well, whatever vaccine rates are in the Cleveland Clinic area, they are sure to go down. Vaccine-preventable disease rates are sure to go up.

My question is this--where are all the pediatricians who ought to be speaking up and out about Hyman and his scientifically and medically illiterate "holistic" family physicians? The apathy from pediatricians over this surging anti-vaccine movement is so profound that I have to wonder if: (1) pediatricians are just feeling beaten down by the increasing tide of AV parents, or (2) most pediatricians just don't care, or (3) they just don't have time to debate, or (4) there a lot more medical/scientific illiteracy among pediatricians than I'd like to think there is.

Could you please explain what you mean by natural childbirth woo

To sum it up neutrally, there are conflicting views about childbirth, in US as well as in Old Europe.

A majority of physicians and gynecologists would prefer a pregnant woman to be followed by a team of a specialists in a clinical setting - or at least to have these specialists at hand, should a complication occur; which means going to some sort of hospital when the time comes.
Especially for a first pregnancy; complications of pregnancy or delivery are rare, but do happen, and saving the baby and/or the mother and limiting lasting damage is often more likely if the right personal/equipment is waiting in the next room.
For pregnancies after the first, now that there is a baseline, both the mother and her medical staff can do a more accurate risk prediction. In the context of previously uneventful deliveries, I could grant that delivering home does not seem unreasonable.
(gosh, it's obvious I didn't attend many childbirths, isn't it? "uneventful deliveries")

On the other side, there are those who feel that pregnancy and childbirth is over-medicalized. If you look into specific interventions, there is room for legitimate debate - when to use of c-section, when labor should be induced...
Science marches on for medicine, as for all other human technologies. There are certainly things we overdo, and others we don't do enough of. Hopefully, ideally, accumulation of data will allow us to correct and improve.

However, when people start talking about how "pregnancy is natural" and "pregnancy is not a disease", we hit the naturalistic fallacy and veer head-on into "natural childbirth" woo territory.
More precisely, these people are going to take health-related decisions based upon an emotional, and above all, false view of reality. Last time I checked, miscarriages are natural and a pregnant woman is not exactly in her usual physiological state. She may not have a disease, but pregnancy definitively qualify as a medical condition.

In the specific case of this Cleveland clinic, the use of homeopathy, and the word "hollistic", are big woo red flags for Orac and most regulars of this blog.

Disclosure of COI: I was born premature and my sister's delivery had to be induced. My mom didn't have ‘uncomplicated pregnancies'.

The Orac quote is framed as for ‘uncomplicated pregnancies’

Well, that's the core of the issue. Until something happens the wrong way, all pregnancies are uncomplicated pregnancies.

And what is wrong with testing functional medicine treatment for various maladies through clinical trials at CCF?

@Eliot

It reads as nothing inherently dangerous...

You appear to be ignoring this bit:

Woman (sic) birth in a variety of positions including in the water...

Newborns have drowned or suffered aspiration to name but two entirely avoidable complications. There is no evidence that water births have ever been the norm in any culture.

As pointed out by the Skeptical OB, most people would not choose to stick their head in water contaminated with blood and faeces, so why would you force a baby to do so.

http://www.skepticalob.com/2014/03/whats-the-difference-between-waterbi…

Dr. Hickie: I'd be willing to bet on #1. Anti-vax parents are so spectacularly aggressive that it's not even worth engaging with them. I suspect that most peds who have to deal with them just don't discuss vaccines more than once, or look for ways to drop the anti-vaxxers as discreetly and fast as possible. It must be very difficult dealing with people who can't hear anything but their own voices and who absolutely despise the doctor for no other reason then their chosen profession. (I wonder why anti-vax people don't just go all the way and learn to set bones themselves.)

Traditional medicine only treats symptoms, like removing a cancer by cutting it surgically, burning it with radiation, or poisoning it with chemotherapy. Integrative medicine treats the underlying cause, which could be something like congested liver qi. Fortunately, there are now advanced scientific instruments to image conditions like this.

http://www.auraphoto.com/products/auracam.shtml

Install one next to the MRI, and you'll be all set.

re #13 Mark Thorson
You couldn't make this up.

Further thoughts on #13
What could save us from this tsunami of drivel is the fact that its purveyors don't accept any test of its effectiveness other than their own opinions. So one man's woo is as good as another's. All woo must be accepted - or none?
Or am I being over-optimistic?

Point well taken about this disappointing focus from CC. However, I must point out that it is VERY misleading to lump natural childbirth in with VAX/autism and metabolic panel science. Many of the practices they list there ARE evidence based (Cochrane on doula support:

(Sorry got cut off- continued http://www.ncbi.nlm.nih.gov/pubmed/23076901) and many interventions considered standard in OB are not at all evidence based (Cochrane review on continuous fetal monitoring: http://www.ncbi.nlm.nih.gov/pubmed/16856111). A portion of the terrifying increase in maternal mortality in the US has been due to an excess of medical interventions (http://www.arhp.org/publications-and-resources/contraception-journal/ma…) and thus dismissing these alternative practices poses a danger to the health and safety of women. We must used evidence based methods to determine proper procedures for any aspect of healthcare but we also must not throw the baby out with the bath, dismissing interventions that aren't familiar without looking at the solid evidence.

oderb #10,

And what is wrong with testing functional medicine treatment for various maladies through clinical trials at CCF?

Functional medicine appears to me to be more of a marketing strategy than a field of medicine: IMO, to quote the Bard, "it is a tale, told by an idiot, full of sound and fury, signifying nothing". If you want an in-depth analysis you could do a lot worse than read Wallace Sampson's articles linked to by Orac in his post.

There are plenty of desperately underfunded scientists with truly promising new treatments that are far more deserving of being tested in clinical trials than "functional medicine".

And what is wrong with testing functional medicine treatment for various maladies through clinical trials at CCF?

Oderb, what body of evidence supports prior plausibility for function medicine's efficacy--i.e., leads one to expect functional medicine is tlikely to produce better outcomes than current standard-of-care science based medicine?

In the absence of such prior plausibility we're better served committing the resources we'd expend pursuing clinical trials of functional medicine to other potential treatments where there is evidence suggesting potential efficacy--and the community the hospital serves would be better served if they committed the resources going to support ther functional medicine program to hiring more nursing staff, reducing wit tiems at their ER, etc/

So what can the average person do to stop the spread of quackademic medicine?

I met someone this weekend who was a patient at the woo part of George Washington University Medical School. The Center for Integrative Medicine that offers quite the menu of quackery.

Traditional medicine only treats symptoms,

Recommending dietary and life-style changes, promoting exercise, providing support and counseling to deal with the emotional effects of illness, etc., only treats symptoms? Really?

Or are you actually unaware that these are all integral parts of conventional (i.e., 'traditional') science based medicine.

like removing a cancer by cutting it surgically, burning it with radiation, or poisoning it with chemotherapy.

By what rational argument does removing cancerous tumors surgically, administering radiation or chemo therapy as curative or adjunct therapies to reduce tumor burden and prevent the recurrence of cancer only treating symptoms of an illnes, not directly treating the illness itself? Explain that one to me.

"Integrative medicine treats the underlying cause, which could be something like congested liver qi."

And your evidence that 'qi' exists, that congestio of liver qi can cause illness. and finally that integrative medicine is capable of releiving that congestion would be...what, exactly?

I mean, you do have some--right?\

Fortunately, there are now advanced scientific instruments to image conditions like this.

Please provide evidence that instrumentsyou claim exist (such as at the website you provided a link to) are actually detecting, imaging, and capable of measuring 'qi', and that they allow the accurate diagnosis of qi 'congestion'.

Install one next to the MRI, and you’ll be all set.

All set to do what? make personalized trippy black light posters?

oderb@10: Your question was answered in this part of Orac's post:

Basically, [functional medicine is] a vaguely defined “discipline” in which it is claimed that measuring a whole bunch of metabolic factors and other lab values will lead to a “holistic” approach to disease. Never mind that just what “functional medicine” actually entails is kept quite vague.

Or to put that another way, it's basically an "underpants gnomes" approach to medicine:
1. Measure metabolic factors
2. ????
3. Patient cured!

The Grouchybeast @ 7. My query was framed around my (now disabused) understanding that none of what was listed in the quote was dangerous. I'm not advocating the idea of integrated sham as a 'pragmatic' rationale for its medical endorsement. However, I'd be concerned with blanket dismissal of benign 'treatments' or approaches that contribute to a woman's birth experience and autonomy over that experience (with the boundary conditions of access/concedance to intervention if required).

DrBollocks @ 11. Not ignoring, merely ignorant on that particular point. Thank you for the link.

Helianthus @ 9. Thank you for the response. I'd think that there is a point between the naturalistic fallacy and recognising the legitimate concerns about the cascade of intervention (and perhaps doctors excessive risk adversity contributing to this?) in childbirth. An expectant mother's birth experience is not irrelevant also, and without understanding any specific point of problematic woo Orac referred to, his brief complaint read (and kind of still reads) as deriding efforts focused on that experience (even if within a medical setting).

However, I must point out that it is VERY misleading to lump natural childbirth in with VAX/autism and metabolic panel science.

No. It isn't. Not really, and especially not when homeopathy is mentioned in the same paragraph.

As a healthcare provider with a chronic, idiopathic, and often disabling disease who has seen some of the top specialists in the country, I can attest to the frustration patients feel in the current healthcare system. I've spent thousands of dollars and untold hours of time trying to find something more than a band aid for my symptoms which seems to be all conventional medicine has for many of us right now. I support EBM and only practice evidenced-based nutrition on my own patients. I totally get it. But the "experts" I've had the privledge to see have spent no more than 10-15 minutes of their time to tell me the same thing: we don't know, deal with it. I hear from my friends who pursue treatment through alternative providers that they spend up to an hour with the "doctor", who then heaps on a lot compassion and willingness to explore "alternatives". So I get why the public is demanding this type of "medicine". They are tired of being treated like ignorant cattle. My husband and I are both highly educated in scientific fields, yet no doctor I've met has been willing to engage in anything more than lay-speak about what "might" be the underlying cause of my disease and symptoms. I attribute this to the fact that they are forced to see way too many patients and have no time to stop and get to know or engage their patients in any kind of meaningful discourse. Until this changes, patient will continue to run to alternative provideres who will. Apparently big centers are realizing this and want a piece of that pie.

As a long-time CCF user, I canned my doctor when she transferred to the wooey "Wellness Dept" and changed to a regular, plain-old primary care doctor who is not interested in the woo in the slightest. She is a no-nonsense, "diet/exercise/get your flu shot" kind of Dr. I tend to think that the majority of Drs. there are like this.

Not that this is news to the people who post here regularly, but doing what "feels" safe for your family is one of the worst ideas I've heard in a long time. It's well established that humans suck at calculating risk - even pigeons do it better than we do! Delaying or forgoing vaccines because it "feels" safer would be like driving your family across America instead of taking a plane because driving "feels" safer, even though you're much more likely to be killed in an auto accident than a plane crash.

Argh - repeat comment <i<and tag-closing fail! The link still works if you click the phrase "even pigeons do it better than we do."

"...humans suck at calculating risk – even pigeons do it better than we do!"

Piazza San Marco in Venice is often carpeted with pigeons. While there (as a tourist) I was horrified to see a couple of young children standing amidst the pigeons and repeatedly trying to stomp them.

Somehow as each foot came down there was bare pavement, not birds. Always. Without seeming to even try they always moved out from under the foot as it descended. It was fascinating to watch. At least once I realized the kids weren't really trying to kill them.

I think, perhaps, if they were woo-believers rather than pigeons they'd get stomped. Every time.

JGC @21

You might want to check the connections on your sarcasm meter.

Quackademic medicine is a weird phenomenon, isn't it? It doesn't happen in other professions - the media don't give Dara O'Briain's "Barry who believes the sky is a carpet painted by God" (it never gets stale) the same credence as professional astronomers, and Barry certainly isn't given an office in the astrophysics department of the local university.

Please provide evidence that instrumentsyou claim exist (such as at the website you provided a link to) are actually detecting, imaging, and capable of measuring ‘qi’, and that they allow the accurate diagnosis of qi ‘congestion’.

I suspect that people are missing Mark Thorson's irony.

Unfortunately, the rise of Quackacademia is often paraded about in woo-ville as evidence that we are indeed in the midst of the Great Paradigm-Shift (tm) which they've been predicting these many years.
'
An idiotic woo-meister can say, " See here: even those in the most admired bastions of SBM are coming over to OUR side!"**
and anti-vaxxers can yelp that " The tide is turning against standard practitioners".

** for some reason,I wanted to write that in LOLspeak. Am I tired or just uncannily perceptive?

About the childbirth stuff some posts back --

Back in the old days, women felt an entirely legitimate beef at OBs who put them up in stirrups and did all sorts of other degrading interventions that had no actual medical legitimacy at all. Natural childbirth arose as a reaction to this.

Nowadays any reasonable hospital offers a much wider variety of options, including getting no interventions unless medically indicated. Given how intrinsically risky the whole business is (as a visit to any 19th century graveyard will attest) I can't see any good reason to choose home birth.

The name *O' Briain* spelt that way always makes me laugh ( so why not *Ui'Briain* whilst you're at it?)
as I know people from (both) Ireland(s) who were persuaded to learn Gaelic- one of whom even finds the trad spelling of Maeve -* Medbh* IIRC- which her neice named her daughter- a bit much.

NIECE- since we're spelling

I could get behind every aspect of "natural childbirth" except the homeopathy & "in the water." While pregnancy is a natural state (not caused by a disease, unless you count the invasion of sperm a root cause), I agree with #9 Helianthus, that it definitely qualifies as a medical condition.

Of course, women have given birth for millennia without professional medical involvement, albeit medical involvement has certainly improved the standard of care (but mostly after the acceptance of germ theory).

Of course, imaging the qi only shows you what is wrong. It doesn't guide treatment. A qi imbalance is usually caused by a blockage of the flow of qi, most commonly a subluxation of a spinal nerve. Fortunately, there are advanced scientific instruments for that too.

http://www.subluxation.com/the-insight-subluxation-station/

Get an AuraCam 6000 and an Insight Subluxation Station, and you'll be all set to practice Integrative Medicine!

AnonRD @ #25: I also have a chronic debilitating condition that has forced me to give up some of the things that I love. My regular MD (whom I see every 2-3 months, because I need monitoring at my medication levels) *always* has time for me, will *always* ask how I'm doing, and the visit isn't over until I have no more questions or reports on my condition. Not every doctor is terrible, but *all* of the woo-meisters are money-stealing frauds who take advantage of people when they are dealing with difficult situations.

I would walk out of a doctor's office if they started suggesting the "alternative" non-working therapies I've seen advertised for my particular condition and its related issues. I know there's no cure for what I have, but easing the symptoms properly matters a lot. I don't want a medical center offering me faith healing or needles in my arms, because they don't work, and it's completely unethical to claim that they do.

One person's bad experience, however bad, does not mean that the woo should be allowed in. Ever.

Since we all already know CCF is following the yellow brick woo, can we have some more thought on WHY they're doing this, such that we could build a case against it that goes beyond pointing out of the umpteen thousandth time that this isn't scientifically sound practice? I mean, do you really think the directors of CCF believe Dr. Hyman is the future of medicine (not rhetorical; I don't know...), or even if so that's all that's going on?

There's exactly one hypothesis in this thread so far, posted by AnonRD.

"No doctor I’ve met has been willing to engage in anything more than lay-speak about what “might” be the underlying cause of my disease and symptoms. I attribute this to the fact that they are forced to see way too many patients and have no time to stop and get to know or engage their patients in any kind of meaningful discourse. Until this changes, patient will continue to run to alternative providers who will. Apparently big centers are realizing this and want a piece of that pie."

So, first of all, are woo patients indeed a significant revenue source for CC? This strikes me as a bit counter-intuitive. If SBM has been Taylorized at CC so real MDs are overloaded and have no time to deal with 'the whole patient' in not-scientifically-invalid ways, why would CAM providers be allowed the extra time for appropriate hand-holding, as that would mean they see fewer patients and, I assume, generate less payment from insurance companies. Am I wrong? Is the profit margin in CAM higher in some way? Hit' em up twice: first for the BS, then the real thing when the B fails? Could they really be that cynical? (again, not rhetorical) Have the CC bosses just thrown up their hands, decided X many people are going to seek CAM regardless, and they might as well get in on the action as their cut will help keep the SBM side of the clinic afloat? Is some other financial incentive other than insurance payments involved? Is there some deep pocket funding source backing these CAM initiatives? A Koch-brother type? Hillary's Wall Street pals? Are some wacko State or Federal legislators pushing this stuff, e.g. the laws in Washington State that essentially REQUIRE Kaiser Permanente to offer woo whether they like it or not?

Could it be that scientific medicine finds itself in a pickle posed by questions the community of scientific researchers is not equipped to answer?

More a habit of mind than a rigorous philosophy, positivism depends on the reductionist belief that the entire universe, including all human conduct, can be explained with reference to precisely measurable, deterministic physical processes. The decades between the Civil War and World War I were positivism’s golden age. Positivists boasted that science was on the brink of producing a total explanation of the nature of things, which would consign all other explanations to the dustbin of mythology. Science was the only repository of truth, a sovereign entity floating above the vicissitudes of history and power. Every schoolkid knows about what happened next: Two world wars, the systematic slaughter of innocents on an unprecedented scale, the proliferation of unimaginably destructive weapons — all these events involved, in various degrees, the application of scientific research to advanced technology. All showed that science could not be elevated above the agendas of the nation-state: the best scientists could as easily be bent toward mass murder as toward the progress of humankind.

T. J. Jackson Lears

If science can't separate it's own strings from social agendas, how's it going to cut the strings pulling up pseudoscience? Follow scientists like Rush Holt out of the lab and into the political arena maybe?

Mike @ #20 asks. "So what can the average person do to stop the spread of quackademic medicine?" and the only thing resembling a strategy I see here is "lump natural childbirth in with VAX/autism" because one woo is a bad as another. I mean, couldn't we just advocate cutting out the homeoquackery, putting the birth-tub down the hall from the OR and having an attending on call nearby?

Yeah, great plan! Let's alienate all the women who want to take a more active, conscious role in childbirth. And it's just a Model of how to win-friends-and-influence people when the first woman to join the thread says 'Many natural childbirth practices are evidence-based and dismissing these practices poses a danger to the health and safety of women.' with three supporting scientific citations, and immediately gets rebuked, 'No. It's not. Because homeopathy.' Shut up, honey, and get on the gurney. You're just irrational because you didn't get the Skeptic Gene that comes with the coconuts.

Hey, there's an idea! We'll get Richard Mellon Scaife to back an advice website for expectant and newborn mom where they learn Rational Thinking from Richard Dawkins, Sam Harris and Michael Shermer (the ladies just Love that guy!). It'll be a subscription-based site, naturally, with a webstore offering copies of 'Atlas Shrugged" autographed by Ayaan Hirsi Ali herself for under $100. There has to be some free content of course, so all the moms who sign up will get an email newsletter featuring reasoned commentary from Ali's colleagues at the American Enterprise Institute about such Mom-crucial issues as getting prayer back in schools, exposing that Anthropogenic Global Warming nonsense as a Commie scheme for the redistribution of wealth, and how Obamacare will rob from their children to give a free lunch to a bunch of wetbacks.

That'll show those woo-meisters in Cleveland in the hard light of Truth, and our troubles here will be over very quickly!

@sadmar

You know, I felt like maybe some of the commenters were a bit hasty in assuming that "natural childbirth" is always code for "scientifically unsupported nonsense that sacrifices women's health and safety to a misguided ideology" (but understandably so since that's so often turned out to be exactly what it is ), but your comment was far more sarcastic and condescending than the ones you're complaining about. As far as the accusation of sexism goes, keep in mind that the natural childbirth movement is prone to its own brand of sexism, namely, "its wrong to use artificial means to make childbirth easier and less painful because childbirth is supposed to hurt, its part of Eve's curse/nature (depending on whether you're dealing with fundamentalist bs or new age bs.)

"why would CAM providers be allowed the extra time for appropriate hand-holding, as that would mean they see fewer patients and, I assume, generate less payment from insurance companies."

Probably because the woo-masters themselves are paid a lot less. To produce a good physician takes more than a decade of hard, expensive training. To produce a good Reiki master or homeopathist takes a couple of weekends to learn the patter. And, of course, a physician requires competent supporting staff and science-based (often expensive) equipment.

What supporting staff or equipment does a Reiki master need? A comfortable "treatment" room is about it.

What about a homeopathist? Well, I guess you need a bunch of little bottles of tap-water, or a pile of sugar pills, plus a bunch of blank labels you can print Latiny names on, but that's about it.

@Sarah A: "your comment was far more sarcastic and condescending than the ones you’re complaining about."

Yeah, that was my reaction too. Of course, sadmar has always been sneeringly condescending to everyone who comments here, so it's not really surprising.

No, no, that approach is all wrong. You'll be dismissed as a reductionist who hasn't learned a darn thing that wasn't taught in allopathic medical school. You're so close-minded you haven't changed your mind about anything since the Reagan administration.

The right approach is to ask how do you image qi? Where is your objective, scientific instrument for locating subluxations? You're using your hands? This is the 21st century, and you're using 19th century technology! You're not competent to practice Integrative Medicine! Either do it right, or get out of the business! This department should be shut down!

What, you're still using needles for acupunture?

http://holistic-healing-center.com/Intro-Seminar-Colorpuncture.html

@sadmar 41
"we could build a case against it that goes beyond pointing out ... that this isn’t scientifically sound practice?"

I thought that was the complete statement of the case against it - what more is there? What else needs (or you feel needs) pointed out in this respect?

@Catherine #16 and #17. Reading through the links you provided, it doesn't support the argument that "dismissing these alternative practices poses a danger to the health and safety of women."

First, the arhp link does not do a great job comparing the different causes of the increase maternal mortality. However, it is very clear that a lot of the increase is due to inadequate access to prenatal, intrapartum, and postpartum care, especially for low income areas. This is not really an argument for alternative practices. It is an argument for building a better health care system with equal acces for all, which I'm sure most here would support.

As to the one of the other link and the arhp, they do indicate that there may be too many medical interventions. However, a decrease in medical intervention does not mean an increase in alternative practices. The author's conclusion from abstract of the article you cite to for doula support states "Continuous support during labour has clinically meaningful benefits for women and infants and no known harm. All women should have support throughout labour and birth."

This again seems tied to the strained resources of the medical system in the United States and supports the development of a better public health care system where medical professionals can get additional information about the mother in order to avoid unnecessary medical intervention. It does not mean alternative birth practices are good and should be supported.

I have to weigh in on the 'natural birth' thing. I'm sorry but I have found only two types of settings for women to birth their babies. You either go with an OB in a hospital with trained staff or you end up at home or a 'natural' birth center. The OB in the hospital may poke and prod more than you like but the epidural is available when you want it (and I wanted it after the first 20 hours or so) and intervention was close at hand. The 'natural' birth center that I had friends who went too offered all the hoopla above, a ball, a water bath (though to be fair I also had a ball before the epidural and did get an hour in the tub) a doula, and assurances you didn't need any 'nasty' painkillers. I know women who wear the badge of honor that they survived their labor with no painkillers and no OB. I don't know why they do this. I was in labor. It hurt, it hurt quite a lot WITH the epidural. Selling women that it will be magic unicorns farting fairy dust and rainbows while they sit in a tub with a doula or half-trained midwife to guide them through is a bunch of baloney. Yeah, we should talk about C-section rates and we could do a lot to make hospital birth better but I'll take it any day over sitting in a water bath for two days being denied pain medication and hoping my baby doesn't drown in the water or get caught in my pelvis or that I bleed to death after delivery.

Kiiri -- Our local hospital (an academic medical center) offers the option of a nurse-midwife service for normal birth - no poking or prodding except as needed and/or desired, and the midwives are highly trained, with nursing degrees and advanced training (Certified Nurse Midwives).

The moment something goes wrong, in comes the OB to consult -- everyone's on salary so there are no turf wars over patients, and the OBs and midwives have an excellent working relationship. And the moment things start to go seriously off the rails, it's onto the gurney and into the OR, usually within a matter of minutes.

palindrom, as usual, beat me to it.

A birthing center...just down the hall from the OR, attended by advance practice nurses/certified nurse midwife, is the third option.

And, there is no shame if you require pain relief for the delivery.

If anyone is interested in a through dissection of natural childbirth I recommend the blog The Skeptical OB.

I love your blog btw Orac.

As someone who sufferers from CFS I am deeply disturbed by the level of woo around it. I go to an integrative medical clinic that is publicly funded. Its called Integrated Chronic Care Services, I think. There is a lot of paraben free, scent free woo- as well as "the dirty dozen' produce, organic, multiple chemical sensitivity etc. People with CFS shouldn't be treated among people with fake diseases like multiple chemical sensitivity. I go because there is a doctor, a nurse, a dietitian, a psychologist and an OT.

I am not happy at all with the woo though being funded by our tax dollars and I am not happy at being suggested by my GP (more than once!) to see a naturopath. If I was an MD I would be so insulted by naturopaths, trying to pass themselves off as legit health providers and all.

I fear that the woo is part of the reason why there is no drug to treat CFS yet. I miss being able to handle a normal amount of exercise and have gained weight from not being able to exercise as much as when I was healthy due to post exertional malaise.

Does Cleveland Clinic still do legit medicine?

I am imagining it as that you only get alt med if that's what you choose but if they are mixing it into real medicine outside of their little Chinese medicine clinic that is very worrisome. Do they choose the integrated pediatricians or is that just what the patients are given by default? I can only imagine how disconcerting it would be to see a highly rated facility you worked at drown into obscurity.

http://www.skepticalob.com/2014/09/microbirth-an-object-lesson-in-the-i…

Actually I lied, there is one drug to treat CFS called Ampligen, which has a lot of interesting controversy around it. Even if Ampligen does end up working I doubt it will help post exertional malaise. They have claimed it could be used to treat Ebola. Sorry to comment spam you btw.

A disturbing example of quackademic medicine at an NCI-designated comprehensive cancer center

oracknows — Thu, 27 Mar 2014 06:00:31 +0000

A disturbing example of quackademic medicine at an NCI-designated comprehensive cancer center

Note: I was busy doing something last night that left me no time to compose any fresh Insolence, which will become apparent by this weekend. In the meantime, however, I'm betting quite a few of you haven't seen this before, and those who have might want to discuss it further in a different environment.

Quackademic medicine.

I love that term, because it succinctly describes the infiltration of pseudoscientific medicine into medical academia. As I've said many times, I wish I had been the one to coin the phrase, but I wasn't. To the best of my ability to determine, I first picked it up from Dr. R. W. Donnell back in 2008 and haven't been able to find an earlier use of the term. As much as I try to give credit where credit is due, I have, however, appropriated the term "quackademic medicine" (not to mention its variants, like "quackademia"), used it, and tried my best to popularize it among supporters of science-based medicine, writing frequently about examples of how quackery has infiltrated the hallowed halls of medical academia, complete with links to medical schools that have "integrative medicine" programs and even medical schools that promoted the purely magic-based medical modalities known as reiki and homeopathy. It's been a recurrent topic on this blog ever since, leading to a number posts on the unethical clinical trials of treatments with zero or minimal pre-trial plausibility, the degradation of the scientific basis of medicine, and the acceptance of magical thinking as a means of treating patients in all too many medical centers.

One strong candidate for quackademic ground zero, if there can be such a thing for the phenomenon like quackademic medicine, which is creeping up like so much kudzu in the cracks of the edifice of science-based medicine (SBM), is the University of Arizona. U. of A. is, of course, the home of one of the originators of the concept of quackademic medicine and one of its most famous and tireless promoters, Dr. Andrew Weil. Dr. Weil, as you might recall, has even been the driving force for creating a highly dubious "board certification" in integrative medicine. Sadly, apparently this new board certification has been so popular among physicians wanting to "integrate" a little quackery into their practices, that its first examination has been delayed from May to November 2014, so that the American Board of Physician Specialties can figure out how to accommodate the unexpectedly large number of applicants.

So what happens when a patient arrives at U. of A. for treatment? I found out last week when I received an e-mail, which led to a fairly long e-mail exchange, with a man whose son was diagnosed with leukemia and is being treated at the University of Arizona Cancer Center (UACC). Although I was given permission to use his name, I decline to do so because there is a child involved, although anyone involved in his case at U. of A. will likely quickly be able to identify who the man is. It turns out that he is a professor at U. of A. in a humanities department (which is why I'll refer to him henceforth as the Professor, as tempted as I was to refer to him as the Real Professor, in contrast to the fake "Professor" over at a certain antivaccine website), and, even though he is not a scientist, he clearly knows how to think (which would not be surprising if you knew what department he was in). In his e-mail, he told me how appalled he was at the sorts of treatments being offered to his son:

I was appalled to discover that the center offers treatments like Reiki, Reflexology, Acupuncture, Cranial massage, etc. These treatments are advertised as "healing"--including boosting one's immune system, complementing conventional chemotherapy etc. I wrote the the [sic] director of the center who at first expressed concern and thanked me for calling these things to her attention. She said she would convene a board of physicians to look into it. After three months went by, I wrote to her asking for an update. She told me the board was still working on it and that she was "confident they would take care of it". I have been asking her for a timeline and she is not returning my emails.

At first I thought this was probably the pernicious influence of Andrew Weil, but I have since discovered that cancer centers around the country are offering these "treatments" including places like Sloan-Kettering. Because of this, I've concluded there is no point in going to the media to try to expose what's going on.

The Professor is probably correct about going to the traditional media, though. There probably is little point in going to the press, although we can always hope. Most of the time, when the press looks into the infiltration of quackademic medicine into medical academia, the result is a story like this appalling one from a year and a half ago in which NBC News chief medical correspondent Nancy Snyderman strongly embraced quackademic medicine to the point that she even said that if a doctor "doesn't know" about integrative medicine, "I think it’s time to ask for a referral to someone who does." It made me sad to see a woman who normally stands up for science, at least with respect to vaccines and combatting the antivaccine movement, to fall so hard for pseudoscience when it exists at Memorial Sloan-Kettering Cancer Center. Even I have had to hang my head in shame when I discovered that my alma mater both for medical and undergraduate school, the University of Michigan, actually has a program in anthroposophic medicine.

Unfortunately, although I hoped that the Professor would make as much of a stink as he could, I felt compelled to warn him that I doubted he would be successful because this sort of “integration” of quackery with academic medicine is very much entrenched at the University of Arizona. It started with the pernicious influence of Andrew Weil, but if Dr. Weil were to drop dead or retire today I doubt that it would change much, if at all, because quackademic medicine has had years to become embedded in the culture there. To put it bluntly, U. of A. is one of the centers of quackademic medicine in the US, if not the world, and I don’t see that changing any time soon. I also looked up UACC's director, Dr. Ann E. Cress, and noted that she’s an interim director, which makes it highly unlikely that, even if she were so inclined, she could do much of anything. An interim cancer center director isn’t going to be able to take on Andrew Weil. It also doesn't help that there are researchers at U. of A. like Dr. Myra Muramoto, who recently scored a $3.1 million from the National Cancer Institute (NCI)—not the National Center for Complementary and Alternative Medicine, mind you, the NCI—to do this:

Dr. Myra Muramoto, Arizona Cancer Center member and associate professor in the Department of Family and Community Medicine at the University of Arizona College of Medicine, has received $3.1 million from the National Cancer Institute to develop and evaluate a new program to train chiropractors, acupuncturists and massage therapists in effective ways to help their patients and clients quit tobacco.

The grant will fund "Project Reach," which will partner over the next five years with Pima County chiropractors, acupuncturists, massage therapists and their office staff to evaluate ways they can best help their patients quit tobacco.

That's a big chunk of change of the sort that cancer centers value above all, money from NCI grants. When cancer centers are being considered for NCI-designated comprehensive cancer center status (NCI-CCC)—or trying to renew their status—one huge consideration is the level of NCI funding its investigators have. Basically, for this purpose NIH grants are good, but NCI grants are the best. That's why any investigator with a $3.1 million NCI grant will have outsized influence and an NCI-CCC or any cancer center seeking NCI designation. Of course, because chiropractors, acupuncturists, and massage therapists often claim, without valid scientific evidence, to be able to help people quit smoking with their woo, such a grant would almost certainly have the effect of encouraging referrals of smokers to these practitioners, to make sure enough patients accrue to the study funded by the grant.

Quackademic medicine at UACC

It turns out that U. of A. does indeed offer its patients tons of "supportive" care therapies not rooted in science. A quick look at its Survivorship Care page reveals:

In collaboration with the medical and psychosocial services at The University of Arizona Cancer Center, we will work with patients to:

Reduce physical symptoms associated with cancer and its treatment (e.g., pain, fatigue, insomnia, etc.)

Manage side effects of chemotherapy and radiation with therapies such as acupuncture, botanicals, and mind-body medicine

Examine lifestyle factors and situations (e.g., diet, risk for undernutrition, physical activity, emotional coping skills, support network, and spirituality) that may affect symptoms and/or course of disease

Develop and work toward goals for health, wellness, and what is most meaningful and valuable after diagnosis, as well as during and after treatment

Actively participate in their health care

Regain a sense of control and well-being despite the diagnosis

Notice the quackademic medicine "integrated" with potentially science-based modalities for supportive care: acupuncture, botanicals, "mind-body" medicine. Note how such useless modalities like acupuncture are listed as being, in essence, co-equal with various dietary, lifestyle, and coping modalities. This is basically how quackademic medicine "rebrands" what should be science-based modalities as somehow being "alternative" or outside the mainstream. It then lumps them together with modalities that are pure quackery (acupuncture, reiki, therapeutic touch, etc.), the implication being that it's all part of a lovely "complementary and alternative medicine" (CAM) package that represents the "best of both worlds." Of course, we at SBM reject the idea that there are "two worlds," citing the oft-repeated adage that there is no such thing as "alternative medicine." Rather, there is medicine that has been scientifically demonstrated to work. There is medicine that has not been scientifically shown to work. There is medicine that has been shown not to work. The reason "alternative medicine" is alternative is because it falls into one of the latter two categories. What do you call alternative medicine that's been shown scientifically to work?

Medicine.

I know, I know. We say this a lot here, but it's true. Also true is Mark Crislip's almost famous adage, which I like to use in almost all of the talks I give about "integrative" medicine these days:

If you integrate fantasy with reality, you do not instantiate reality. If you mix cow pie with apple pie, it does not make the cow pie taste better; it makes the apple pie worse.

As I've said many times before, I wish I had thought of this quote.

Trying to hide the stench of cow pie in the apple pie

Make no mistake about it, UACC is "integrating" fantasy with reality by offering reflexology (or, as I like to call it, a nice foot and hand massage with delusions of grandeur), reiki (or, as I like to call it, faith healing substituting Eastern mysticism for Judeo-Christian beliefs), craniosacral massage (or, as I like to call it, a nice scalp massage with delusions of grandeur), healing touch (also known as therapeutic touch, which I like to call reiki without the foreign name), and many others. At least, I wasn't able to find anywhere that the UACC offers homeopathy to patients, although one of the most famous of the "magical grants" awarded by NCCAM was to a University of Arizona researcher in Dr. Weil's department to study homeopathy.

It didn't take too long for it to become clear to the Professor that UACC was not dealing with him in good faith. At least, that's what he told me in a subsequent e-mail. What led him to believe this was a combination of not getting his e-mails answered and then what happened after he complained about perhaps the most egregious example that he found at UACC. He first brought this issue up back in December, and, after several requests to have a meeting, the Professor became frustrated and basically sent a threat to go to the media. Shortly after that, the web page on the UACC site that had so disturbed the Professor became this:

Yes, that's a big "Access Denied" message. One wonders whether UACC deleted the page or just hid it so that you need a University of Arizona login to see it. Maybe one of our readers from U. of A. could check and report back here.

Thankfully, due to the magic of Google Cache, we can see what was there until as recently as a week ago:

One wonders if the administration of UACC, out of concern that the Professor might actually do what he said he would do (shop his story around to newspapers), got rid of the web page for Frank Schuster. Of course, it's not so easy, as I showed above, and, in case anyone's interested, I've saved a web archive of the page for permanent archival purposes (for me, that is).

I can see why the UACC administration would be embarrassed enough to act like this. On the now defunct page, potential patients for UACC were treated to incredible claims like:

Very simply, Reiki is energy that flows through the body of the practitioner, and conveyed through the hands into the body of the recipient. It is subtle energy, but it can be felt – usually as a warmth, tingles or slight pressure.

And, perhaps the most ridiculous claim of all:

Any particular effects cannot be predicted. The energy is intelligent and it will do whatever is best. What can be stated is that it will help any condition.

That's right. Apparently this "healing energy" from the "universal source" is so intelligent that it will do whatever is needed or best. That totally must be why it can't be studied! Its effects are so darned unpredictable! It's also hard not to note that on the old web page about Mr. Schuster there was a link to his practice's web page Energy-Therapy.net, where there's also a link to his blog Energy Therapies, which appears not to have been updated since 2005 but is quite revealing nonetheless. Indeed, in one post on Mr. Schuster's web page, we see a claim that speaks for itself:

ALL illness and disease are indications of an unbalanced or depleted energetic condition. The resulting manifestation as pain or anxiety is the body’s way of letting you know that something in your life is out of balance.

But don't worry, Mr. Schuster can help. You don't even have to come to his practice or UACC! That's because, you see, Mr. Schuster offers distance healing:

Distant Healing is defined as a "mental intention on behalf of one person, to benefit another at a distance."

In this context, prayer is a mental act of intercession in which the believer (pray-er) puts himself “between” God and the recipient.

God then uses the prayer (pray-er) as the conduit for the request – be it healing, therapy, or another type of petition. God’s healing power is directed through the healer to the person in need. If that person is present, the power can be conveyed through touch. In the event that person cannot be present, God’s healing power is effectively conveyed by mental intention through the thought process. In this realm distance is not a consideration.

One might not believe any of this, nor have faith that this kind of healing can occur. Actually, that is irrelevant. The only faith that really matters is that of the healer or pray-er. The single requirement of the recipient is to be in a receptive mode, open to healing possibilities. It is not necessary to believe that the acts of prayer, distant healing or touch healing are effective.

This is, of course, completely unscientific. It's religion, pure and simple. In fact, I would argue that it's just another form of faith healing, given how Mr. Schuster invokes God as the source of the "healing power." And it's only $25 for four 15 minute sessions! (More if you want to donate more.) What a bargain! At least there's a quack Miranda warning at the bottom of the page, and one notes that Mr. Schuster also includes a plug for NCCAM.

I don't know whether Mr. Schuster actually offers distance healing to UACC patients, although it's clear from his web page that he offers it. Regardless of whether he offers it to UACC patients or not, I hope that I would not be alone in arguing that mystical nonsense like reiki (which Mr. Schuster appears to implicitly admit to be faith healing) has no place in an academic medical center, much less an NCI-CCC like UACC. There are only 41 NCI-CCCs in the entire country. I'm faculty at one and am proud of having been on the faculty of two different NCI-CCC's. The NCI designation is supposed to mean that these cancer centers are the best of the best, adhering to only the highest standards of patient care, research, and community engagement. To see an NCI-CCC offering faith healing, distance healing, and treatments based far more on magical thinking, religious and mystical ideas, and prescientific concepts of disease, such as reiki, reflexology, and acupuncture, embarrasses me almost as it would to learn these modalities were being promoted for patients by my own cancer center as though they were legitimate treatment modalities. Fortunately, they are not, which is one reason I'm proud of my cancer center, but I nonetheless fear this occurrence. After all, if M.D. Anderson Cancer Center and Memorial Sloan-Kettering Cancer Center can fall so deep into the rabbit hole of woo, I'm under no illusion that it can't happen where I work too. All it would take is a new cancer center director, a new director of supportive services who is more "open" to these sorts of treatments, or maybe a new member of the board of directors who is woo-friendly. SBM is fragile these days.

Perhaps Dr. Cress feels the same way, along with many of the other excellent science-based clinicians and researchers based at UACC. I doubt it's a coincidence that there isn't a single mention of CAM or "integrative medicine" in a recent history of UACC published on the UACC blog last fall. In a way, I feel a bit sorry for Dr. Cress in that, as an interim director, she probably has neither the authority nor inclination to deal with this issue definitively. She probably wants to let whoever is appointed the next permanent director deal with it. Whatever the case, the Professor still doesn't know whether Mr. Schuster is still affiliated with UACC or not, the removal of his web page from public view notwithstanding. I'm not sure that even the minimal action of removing from the UACC website a webpage that links to a website offering distance healing would have happened if the Professor hadn't been faculty at the University of Arizona and threatened to go to the press.

Maybe they were concerned that people would also notice that Mr. Schuster's other website, Paths-Mind-Is-It.com, offers a veritable cornucopia of dubious products, such as Increased Synchronicity, which claims to be able to:

Increase in awareness of the present moment. Fully appreciating the here and now

Have future self send information back through time to current moment. This is specific for the following periods of time...1 minute, 1 day, 1 week, 1 month and 3 months

Have current self send current information back through time to past self. This is also specific for the following periods of time...1 minute, 1 day, 1 week, 1 month and 3 months

Increasing unity/harmony between past, present and future self

Hey, if Mr. Schuster can send healing messages over distances, why not forward or backward in time, too? Yes, basically, his PATHS "utilize proprietary breakthrough technology" that claims this:

Rapid Data Transfer (RDT) GENERATION II embodies a quantum leap in Mind Technology. RDT Gen. II is a unique technology that helps you use the potential of your own mind without any drugs or medications. It can help you to improve in almost every area of your life including, health (physical, mental, emotional & spiritual), enlightenment, productivity, success, communication, finances, relationships, fitness and sports - even improve your memory!

RDT has been helping thousands of individuals, like you, improve their lives in many ways (click here to read success stories) in as little as 3 minutes a week.
RDT or Rapid Data Transfer facilitates high-speed communication between an on-line Theater Presentation and the human subconscious.

As best I can figure, PATHS are multimedia computer presentations that claim to be able to do all sorts of things for you, including improving your stem cell health, strengthening your connective tissue, and doing quantum meditation. Note that the word "quantum" features prominently in this "technology," and regular readers know what the use of that word almost always indicates in this context.

What remains of the cow pie

Even if Mr. Schuster is indeed gone from UACC, there's a lot of woo that remains there, as the Professor mentioned in his e-mails. Specifically, he pointed out something called The Seven Levels of Healing, a program created and offered by Dr. Jeremy Geffen, MD, FACP, who is described as a "board certified medical oncologist and leading expert in integrative medicine and oncology and is the author of the book The Journey Through Cancer: Healing and Transforming the Whole Person." I think I'll quote the Professor about why he found this so objectionable, because, really, without letting myself go, I'd have a hard time putting it better myself. In his criticism, the Professor also cites examples from Dr. Geffen's website:

Today I'm in the cancer center and I've noticed something else. You offer here something called "The Seven Levels of Healing". I looked up this program. Level 7 is about the nature of spirit. Here's one thing they say:

Spirit is our true nature: timeless, eternal, and dimensionless, the source from which all awareness, all creativity and, ultimately, all healing flows.

As you know, this claim is scientific nonsense. One may have religious faith in such a claim, but is it appropriate for this claim to be made by the cancer center? The description continues:

The goal of "The Nature of Spirit" is to assist each person to discover this spiritual aspect of themselves, and to bring this into full, ongoing awareness. When what we experience as physical reality is threatened, it is more important than ever before to remember that another part of us is timeless and eternal, and remains strong, healthy, and powerful, no matter what our physical circumstances may be. In recognizing the nature of our spiritual selves, and the incredible mystery of awareness itself, we uncover the source of ultimate love and freedom -- an infinite ocean from which healing can be drawn.

Again, completely unscientific claims about healing. As far as I know, the "Seven Levels of Healing" program is free. This makes it less objectionable, although in my mind, it is still objectionable for the cancer center, a supposedly scientific, evidence-based institution, to be pushing what is essentially religion. Moreover, in the description of level 3: "The Body as Garden", they say the following:

Here we explore the full spectrum of complementary approaches to healing: nutrition; exercise; massage; yoga; herbal therapies; Ayurvedic, Tibetan and Chinese medicine; acupuncture; homeopathy: chiropractic; and visualization. We do not offer or promote these approaches as cancer treatments per se, and we do not believe that they should be viewed in this manner. However, we do believe that they can supplement conventional care by cleansing, toning, relaxing, and strengthening the body, thus giving health and well-being the greatest chance to emerge.

Although these claims are vague, it would be quite natural for someone to interpret them as meaning that these treatments, some of which are offered at the center for a fee, can aid in one's recovery from cancer. I know of no evidence to support this claim. And do you have any idea what they mean by 'cleansing' and 'toning' the body? Do these terms have any scientific meaning in this context?

Likely, the Professor learned of this program through a fliers or pamphlet like this one. He is quite correct, too. By offering this particular program, UACC has irresponsibly placed its imprimatur and thus the assumed imprimatur of science on pseudoscience and mystical, religious mumbo-jumbo. There is no excuse for this.

This "Seven Levels of Healing" represents a program by a physician who is not UACC faculty but is promoted by UACC to its patients. It offers homeopathy, which, no matter how much homeopaths try to deny it, is pure quackery, as we've described many, many times here. Ayurveda and traditional Chinese medicine are modalities based on prescientific ideas of how diseases work not unlike the four humors in prescientific European medical traditions. Worse, according to the biography on the website, Dr. Geffen is apparently "focused on implementing 'The Seven Levels of Healing' program in cancer centers throughout the United States, along with writing, speaking, and consulting with hospitals, cancer centers, and professional organizations in developing leading-edge integrative programs for medicine, wellness, and life." Although several cancer centers appear to have adopted the "Seven Levels of Healing" woo, from what I can tell, UACC is the only NCI-CCC that is involved, making it by far the most prominent cancer center to be using Dr. Geffen's program. I really hope that I don't learn of any more.

Given the infiltration of quackademic medicine into even the most respectable medical centers, it's hard to know whether UACC is merely the cancer center that's gone the farthest down the rabbit hole of pseudoscience or whether I just don't know of ones that are even worse. Given the large shadow that Andrew Weil casts over the medical school there, it might well be so that, when it comes to quackademic medicine in oncology, UACC reigns supreme. As prominent as M.D. Anderson and Memorial Sloan-Kettering Cancer Centers are, as far as I can tell, neither of them has yet offered distance healing to their patients, although many are the academic medical centers that offer a quackery only slightly removed from distance healing, namely reiki. After all, what's the difference between saying you can channel "healing energy" from the "universal source" into a patient if you're in the room with him or if you're thousands of miles away? In my mind, not much. At least one academic medical center offers homeopathy. (Actually, I wish it were only one.)

Can anything be done?

Often, I'm asked something like, "What's the harm?" After all, UACC and the other cancer centers that offer up "integrative oncology" don't deny patients science-based treatments for their cancer. True enough. However, as the Professor demonstrates, the existence of "integrative oncology" programs has a profoundly confusing effect on patients and their families, who, quite reasonably, assume that an NCI-CCC would not offer any treatments that were not science-based. Consequently, the line between science and pseudoscience is becoming increasingly blurred, to the point where even a lot of physicians have a hard time telling the difference when it comes to modalities like acupuncture, which has been the most successful at projecting a facade of science over prescientific mystical origins and a mid-20th century resurrection based on political need in China, thanks to low quality studies and random noise in clinical trials. Worse, this infiltration has led to grossly unethical clinical trials, such as the Gonzalez trial, in which patients undergoing a "natural" therapy for cancer did much worse than conventional therapy, even for a disease with as grim a prognosis as pancreatic cancer. Perhaps an even more pernicious effect (actually, there's no "perhaps” about it) is that this blurring of the lines between science and pseudoscience so badly batters the filters against pseudoscience that a cancer center like UACC can allow practitioners like Frank Schuster and Dr. Jeremy Geffen to be associated with its programs, and even hire them to provide unscientific medicine.

My first wish is that more patients like the Professor would so vigorously protest the infiltration of quackery into academic medical centers like UACC. My second wish is that it would take more than the potential embarrassment of publicity about a practitioner that even the quackiest of quackademics can't defend to push a cancer center to act to protect the scientific basis of cancer care. Maybe the Professor can serve as an example of the first wish, but I fear I will not live to see the second ever fulfilled.

oracknows Thu, 03/27/2014 - 02:00

Categories

Education

Pushback will have to come from patients.

Otherwise, quackademic centers will continue to feel a need to compete with the woo offered at places like Cancer Treatment Centers of America. For instance, laughter therapy.

Who cares about survival rates, when you can have laughter clubs?

http://www.cancercenter.com/treatments/laughter-therapy/

This is why I worry somewhere there is a peds heme-onc physician who just might cave/fall for Burzynski's snake oil.

Have there been any articles by oncologists that have come out strongly against this quackademic infiltration of science-based medicine (other than, of course, ours truly)?

@ Chris Hickie:

I have a cousin who has terminal lung cancer - he lives thousands of miles away- I only talk by phone- but from what I can gather, both he and his wife could benefit from *science based* services at this time. I suspect that most of these are readily available but they are currently in a frozen state of shock. Hopefully, they will respond when the services are offered- he does receive home visits from a nurse weekly.

People undergoing this situation need professional help- such as counselling and perhaps guidance about dietary interventions and pain medication.

Should institutions and governmental supplements for health care be squandered on reiki and accupuncture when money might be better spent on dieticians and counsellors?

AND I'm not just saying that because of my own area but because this assistance is based on DATA.

What's truly insidious about quackademic medicine is that most laymen aren't (and cannot be expected to be) as well informed as the Professor. He seems to have an especially well-developed BS detector (possibly due to his teaching and grading duties), and he is confident enough to recognize that someone affiliated with Erehwon University Hospital might be spouting nonsense. Most laymen would see the Erehwon University Hospital seal of approval and reasonably assume that there was something to it, even if "it" were an alt-med treatment mode as ridiculous as homeopathy or touch therapy (the latter was debunked by a then nine-year-old girl in a science fair project, for crying out loud).

I am a skeptic and a critic! HOWEVER I used to weight about 240 Pounds, then i lost over 70 pounds. The problem was my posture was very misaligned, my neck and back. I did 4 months of chiropractic and my back actually straightened by more than 15˚ and my neck by more than 18˚. How are you going to sit here and tell me that this is quackademic when it made me better??? Of course I did phyiscal therapy (a few minutes lifting weights at the center) after each adjustment. I have xrays that show the difference in change in my back and neck. How can you say this didn't help me?

Speaking of homeopathy...

http://www.wired.co.uk/news/archive/2014-03/25/homeopathy-contains-medi…

I know it's cliche, but this may be one of those things that may have to get worse before it gets better. I just hope we don't have to get plunged into a new Dark Ages by the anti-science movement before everyone else wakes up and starts pushing back, demanding real science and real medicine. I'm glad this Professor is doing all he can to fight against it. Let's hope he can rally his colleagues in the science departments into backing him.

Integrative Medicine is here to stay, for now. It's sad to see so many doctors taken in by it, including Dr Snyderman; it's difficult to know who are the true-believers and who embrace it to stay competitive.

As far as Dr Weil is concerned, he is actually a rather divisive figure in the alt-med community. Sure he's popular, but there are many people in the alt-med movement who see Dr Weil as a "traitor", or some kind of "allopathic" infiltrator of the movement. Many resent him for helping create the board certification in integrative medicine. Some also resent him for creating integrative medicine to begin with, since they believe all scientific or "allopathic" medicine is worthless or evil, and they're not integrating their homeopathy, or reiki, or herbalism with that!

Ayurvedic, Tibetan and Chinese medicine

Uh-huh. Apparently, Ayurveda and TCM just weren't obscure enough. The irony of holding that "Lhüng disorders" are caused by materialism and attachment ("Bheygan disorders" are due to ignorance) while simultaneously fetishizing the Dalai Lama is predictably lost on this crowd.

Cooper @6 - I'm not an expert, but I think that most folks around here don't dismiss the idea that chiropractors could have some benefit in cases such as yours -- you had a structural issue, and manipulation could have helped it a lot.

But hard-core chiropractors believe that practically every disease traces to some kind of misalignment of the spine -- they base these beliefs on the 19th-century doctor who started the field. At this point can be pretty sure that that part of the subject is nonsense.

#6 Cooper

Well, posture doesn't seem to be emphasized today as part of medicine, but it was commonly considered part of health and character in the first part of the 20th century. It still is, but it is appreciated in fewer places.

It sounds like your back was severely out of line, and the crude methods used by chiro were better than doing nothing. Glad to hear it worked out for you.

But ... if one either doesn't have severely misaligned spine or has that problem and a good physical therapist able to deal with it, I'd avoid the chiropractor.

I used one myself for a while to deal with back pain as I had an acquaintance who said he got good results from one particular chiro, and I thought chiros as "the back pain fixit people". I now understand them as an odd combo of useful physical therapy, excessive x-rays and possible back injury from forceful spine movement. So ... now l look elsewhere to fix back and posture issues.

We've fumed for a long time over patient testimonials. Quackademic alt med, I think, implies a testimonial from respected mainstream institutions. Just after reading this blog this morning, I stumbled on this discussion of Ayurvedic treatments on a cancer patient message board:

"I have not tried it, but I noticed that it is offered at our big comprehensive cancer centers in Ohio... [she names three mainstream cancer centers]...so it's not too far out there."

It's a really good way to lull the patients so they don't notice they've entered fantasyland.

" I was busy doing something last night that left me no time to compose any fresh Insolence, which will become apparent by this weekend. In the meantime,"

Will there be an announcement, or should we just check arrest records?

Patience, Grasshopper. When you can snatch the pebble from my hand...

The Center for Integrative Medicine at University of Colorado Hospital (NCI-CCC)
http://www.uch.edu/conditions/integrative-medicine/

With a big ole front page "Featured News Story: Acupuncture for Cancer."

Shoot me now.

University of Pittsburgh (NCI-CCC)
http://www.upmccancercenter.com/SupportiveCare/integrativeMedicine.cfm

UPMC CancerCenter Integrative Medicine Information Service (IMIS) provides access to complementary and alternative therapies to assist in managing your symptoms. These types of therapies may also assist in preventing a cancer from forming or returning.

The program offers information regarding:

Herbal and dietary supplements
Acupuncture
Healthy eating
Mind-body medicine
Additional therapeutic approaches

IMIS specialists work directly with your cancer care team to integrate alternative medicine approaches into your treatment plan.

Dana-Farber (NCI-CCC)
http://www.dana-farber.org/Adult-Care/Treatment-and-Support/Patient-and…

Despite the documented benefits of complementary therapies, most insurance plans will not pay for them. Our mission is to make integrative therapies available and affordable for all Dana-Farber patients.

A past president of the American Cancer Society and a professor at Harvard Medical School, Dr. Rosenthal has embraced integrative therapies as a vital component of his own oncology practice.

Yep, even Barbara Ann Karmanos/ Wayne State University
http://www.karmanos.org/cancer-care/patient-center/support-education/in…

Integrative Therapies & Services

Integrative therapies are used in combination with cancer treatment to treat the whole patient, mind, body and soul. These therapies place an emphasis on decreasing stress and anxiety, while improving one’s general sense of well-being. At the Karmanos Cancer Center we offer a variety of integrative therapies including:

Art therapy
Healing touch
Massage therapy
Pet therapy
Reiki
Yoga

Ayurvedic, Tibetan and Chinese medicine
Uh-huh. Apparently, Ayurveda and TCM just weren’t obscure enough.

A situation, I suspect, of some fantasist deciding "I want to make stuff up" and feeling his imagination too constrained by the body of made-up stuff that already exists for Ayurveda and TCM.

A situation, I suspect, of some fantasist deciding “I want to make stuff up”

"Therapeutic fan-fic", is basically what I'm saying.

Pet therapy -- when my uncle was dealing with dreadful health problems (including cancer) toward the end of his smoking-truncated life, he had a little dog who cheered him up greatly.

It's more than doubtful that this had any effect on his cancer, but it enhanced his quality of life quite a bit.

Palindrom,
Absolutely! The touchy-feely, stress relieving, comforting, make-you-feel-nice, distraction, massage, friendly shoulder to cry on, puppy kiss, etc., treatments are a HUGE and welcome benefit to many patients. No doubt about that! My issue is simply the exaggerated and bogus "healing" claims surrounding them.

When the AMA did a federally funded study comparing naturopathic medicine with pill and cut methods they were embarrassed when they had to admit naturopahic medicine was more effective. They tried to supress their own research but had to release it due to the federal grant that paid for it.

Pubmed link, please?

thenewme @22 -- We are in perfect agreement.

I think it's important for science-based medicine folks to be very clear that they understand the palliative and quality-of-life value of SOME of this stuff, so they don't come across as inhuman scolds. But of course, humane sympathy and warm-heartedness do not require checking one's brains at the door.

(Excessive capital letters below by deliberate design, heh heh;-)

Dear Mr. Schuster:

Can you use Distance Healing to channel some Reiki Energy for me? I am on a Quest for the True Nature of Energy, and since you say the Energy is Intelligent, it should be able to do this.

I have here on my desk, a BBC/Goerz-Metrawatt MA3E multimeter, with the Negative lead connected to Ground (I understand that for Healing Energy to work, one needs to be Grounded), and the Positive lead pointing straight up in the Air. The meter is set to read 10 Microamps full-scale, so even one Microamp will be sufficient to give an unambiguous Reading.

If you agree to provide your Help in my Energy Quest, I shall switch on the meter at a time of your choosing. I am eager to receive a good Reading on my Meter, so I'll be happy to send payment for your Services before we proceed.

Sincerely yours....

The point of the preceding comment being, if something is claimed to be energy (or, ahem!, Energy), then it should certainly be measurable. As I like to ask when I hear people talk about 'Energy', 'How many milliwatts per square metre, and how is it measured?'

As for the woo poo at NCI-CCCs, IMHO it would be legitimate if they said something like the following (this is serious, not sarcasm):

"Many cancer patients and their families find it is very helpful to engage more fully with whatever philosophical, religious, or spiritual beliefs they may hold. We can provide a list of local resources that cover the range of Western, Eastern, Indigenous, and Non-Theistic beliefs, traditions, and practices. This list does not constitute and endorsement by the Cancer Centre of any system of belief or practice, and no medical benefits should be expected from participation." Full stop, nothing more.

While it is reasonable for a doctor to ask patients and families about their 'emotional and spiritual wellbeing' in a general sense, I for one would be rather upset to be subjected to proselytising for a belief system that had no basis in empirical science and that I did not hold as a philosophical matter. Contemplating Max Tegmark's multiverse theory is one thing; getting asked if I'm 'saved' or the Eastern equivalent thereof, is decidedly another.

Capital TOM:

i'm going to stick my neck out and call Bullshite.

Lurker #27 -- if it's milliwatts per square meter, it's power flux, not energy.

I, for one, do not confine my insufferable pedantry to linguistic matters.

Lurker - sadly, your experiment is doomed to failure because your meter is Grounded in Negativity! While it is to your meter's credit that it is waving its Positive lead in the air, the Energy will avoid all that Negativity lest it be Bummed Out. The only solution would be to eliminate the Negative Pole entirely and Positively Ground your machine, possibly with a Coffee Grinder.

If or more likely when I get cancer or some other disease, and someone offers to sell me magic water or reiki or some other garbage, then I will most likely try to recall any of my old Tae Kwon Do training and give them some decidedly therapeutic touch. It'll make me feel better, at any rate, and perhaps make the world a better place. Maybe they'll even get a Darwin Award out of it, so wins all around.

Of course the first thing I did after reading your post (my first introduction to your work - nice job) was to look at the Comprehensive Cancer Center at my institution - Northwestern University. Sure enough, under "Specialty Cancer Services," they advertise a program in Integrative Medicine: http://cancer.northwestern.edu/public/why_northwestern/specialty_progra…

I should also like to note the official motto that has graced Northwestern's seal since 1890: Quaecumque sunt vera (Whatsoever things are true)

(excessive capitalisations intentional;-)

Palindrom @ 29: Ooops. I based that on 'watts per square metre' which is a measure of solar radiation and used in conjunction with photovoltaic (solar power) installations. What I'm looking for is a pithy way of saying 'show me an objective measure of your so-called Healing Energy.'

Mephistopheles @ 30: Oops again!, Grounded in Negativity, glad I checked it here before sending that to Schuster. But if the Positive is Grounded, then we have the problem of the Negative probe in the air, which would be seeking to receive Negative Energy. Maybe I should ask Schuster which setup his Intelligent Energy would prefer.

Herry @ 31: Now now, it's not up to you to be an Agent of Karma, much less launch any hapless fools into their Next Incarnation. Instead, seek to Channel some Life-Affirming Energy to illuminate the errors of their ways, and trust the Spirit to guide them.

---

Seriously though:

Thinking of martial arts manoeuvres, I wonder about the possibility of 'grounding' all this 'integrative medicine' by way of finding science-based treatments and palliative modalities that can be described in vaguely wooey terms to make them attractive to the woo-seeking crowd? Also, removing all diagnostic/treatment language from the more harmless forms of woo, and describing them in ways that are attractive to that audience but don't promise any medical benefits as such?

Yoga (as exercise), massage (for relaxation), meditation (for reducing stress), etc. etc. The woo modality that consists of looking at coloured light could be reframed as purely an exercise in sensory pleasure, like looking at the blue sky or a sunset.

The goal here is to 'speak their language' and offer something that provides emotional affirmation, sufficient to help get them onboard with SBM for the actual diagnoses & treatments.

For example I wonder how often oncologists who are mainstream-religious, say to their patients who are also conventionally-religious, something like 'I'll be thinking of you in my prayers'? From the doctor's perspective, it's a sincere kindness. From the patient's perspective, it's affirmation of their faith and it shows solidarity. Objectively, it's emotional support, even though it's not part of the treatment (e.g. chemotherapy).

If something like that could be done for patients who subscribe to various forms of animism, I can't see that it would be harmful. It doesn't do to proeslytise atheism to one's Protestant or Catholic patients, so the same case should obtain for one's animist patients. Just as long as they agree to use SBM for the actual diagnoses and treatments, other things that help them feel better emotionally should be OK.

Radiation therapy really sends the healing energy into the body where it can kill the bad cancer cells. And, if you're not trying to cover the whole body so you can kill the nasty cancer cells wherever they pop up, there are ways of targeting the healing energy such as choosing the energy for charged particle irradiation to deposit most of the energy at the depth of the cancer site.
It's been a while since I studied health physics, but I'm sure the box of blinking lights is much more aware of current techniques.
And, with charged particle accelerators, you direct either positive or negative energy!

Lurker,

I am ok with sharing belief systems, but there are a few requirements that I would require of my medical team:

a. Be sincere. Don't pander to me.
b. Be upfront about it being palliative not a treatment.
c. Free is best, but if you are going to charge for it don't offer it to me unless I understand item b. thoroughly.
d. Don't replace SBM with it because you can charge a lot for it and deliver it cheaply relative to SBM - which I think is where we are headed in the States at least.

"requirements that I would require"

I apologize for the redundancy; NyQuil wore off and fever is kicking in.

I had intended on writing a more scathing/in-depth response to your egotistical out-pouring's but I'll say this instead: There are none so blind as he who will not see. The mass exodus of patients from this perception of healthcare is its own doing based on its arrogance and performance. To dismiss something because the jargon that is used doesn't fit your palate is unscientific and again arrogant. Search the NIH for reiki and 87,000 results will emerge, yoga and 219,000 will. You are in a lesser group that thinks these ideas aren't worth looking into for patient care. Lastly, imagine if a doctor were paid by their patients as long as they were healthy and not paid while they were unwell. It would be in the doctors best interest to be a master of health and not a master of sickness.

"The mass exodus of patients from this perception of healthcare is its own doing based on its arrogance and performance."

Citation needed.

"Lastly, imagine if a doctor were paid by their patients as long as they were healthy and not paid while they were unwell."

How would that work for those who have genetic conditions like cystic fibrosis or obstructive hypertrophic cardiomyopathy? Or perhaps getting cancer, like leukemia or cervical cancer?

Or do you just think it is cool to blame the patient? And why demonize those who try to educate the public on useless things like "energy" medicine?

(by the way, yoga is a nice kind of exercise, and exercise is part of mainstream medical practice)

Search the NIH for reiki and 87,000 results will emerge

If you mean PubMed, you're off by a factor of 468, and a glance suggests that a good number are in the usual low-quality places.

And here, I was thinking that Reiki is a hands-off treatment. I was wrong.

http://www.ncbi.nlm.nih.gov/pubmed/23617447

Absolutely! The touchy-feely, stress relieving, comforting, make-you-feel-nice, distraction, massage, friendly shoulder to cry on, puppy kiss, etc., treatments are a HUGE and welcome benefit to many patients. No doubt about that! My issue is simply the exaggerated and bogus “healing” claims surrounding them.

The University of Colorado Hospital stuff, at least, looked to me as if it fell short of "bogus." (As one might expect, in light of the potential legal repercussions.)

It definitely disturbs and distresses me that people evidently can't tell when the words in the "Our Services" brochures they're reading mean anything or not. The unhappy implications of it aren't confined to alt-med. (Or, ftm, med.)

But I'm not sure I'm outraged by all of it, per se.

And (more to the point) I'm also not sure that TCM-as-offered-and-practiced-at-the-University-of-Colorado-Hospital (as opposed to TCM) is harmful, per se.

A lie-down-with-dogs argument could be made, I guess.

...

I don't know. I don't see a good argument in support of it. And it wouldn't be for me, personally.*** I'm just not sure I oppose it adamantly.

*** Although I might like the pet and/or art therapy. Lanyards!

This is a thing of beauty:

The treatment of cells with acupuncture involved opening the flask in a level 2 biosafety cabinet and placing a standard steel acupuncture needle in the flask of cells making sure the cell layer was in contact with the needle tip for 20 mins. Sham controls included opening the flask for the same length of time with no needles or exposure using plastic toothpicks instead of acupuncture needles.

You (and the Professor) don't appear to understand the difference between complementary treatments designed to offer symptom relief and reduce the side effects of conventional cancer treatment and alternative treatments that purport to affect the disease process itself. Integrative medicine is generally careful to align itself primarily with complementary treatments and with the best research-supported alternative treatments. Your assumption that integrative medicine practitioners make no such distinctions is contradicted by the fact that there have been integrative medicine practitioners and researchers in major medical centers for more than two decades, and virtually all of them would support the use of conventional therapies that have a research-supported track record of effectiveness (it may surprise you to discover that not all conventional therapies can make that claim). Check out Deng and Cassileth in the November, 2013 issue of National Review of Clinical Oncology: "Complementary and alternative medicine in cancer care - myths and realities" for a good statement of integrative medicine's perspective on this.

Meanwhile, I would suggest that you do less name-calling and read more of the research literature about complementary and alternative medicine. The term "quackademic" is basically short for "I've stopped thinking about this because of my prejudice for mainstream science and I want you to stop thinking about it, too."

Oh, I understand the difference between "complementary" treatments designed to relieve symptoms and alternative treatments. You're also attacking a massive straw man, as I never said that "integrative practitioners" make no distinction. Rather, I view that distinction as being one without a real difference. They still use a lot of quackery.

Reiki is quackery. Acupuncture? Quackery. Homeopathy? Quackery. "Therapeutic touch"? Quackery. "Energy healing"? Quackery. Chiropractic? Large swaths of it are quackery. Naturopathy? Ditto. That's the point. "integrating" these modalities with SBM, as "complementary" therapies or whatever is still quackery. I suppose it's not as bad as using quackery to try to treat the cancer itself, but just because it's "not as bad" as using alternative medicine to treat cancer doesn't make it good. It's still bad.

If only all the quack modalities are offered with a nice big upfront bold statement that "This modality may make you feel better but it will not make you better"

Check out Deng and Cassileth in the November, 2013 issue of National Review of Clinical Oncology: “Complementary and alternative medicine in cancer care – myths and realities” for a good statement of integrative medicine’s perspective on this.

Are you sure you've read it yourself? That's not the name of the journal, and it's paywalled. Anyway, it's not too difficult to find Cassileth's distinction:

"Complementary therapies are distinct from so-called 'alternative' therapies, which are unproven, ineffective and may postpone or interfere with mainstream cancer treatment. Complementary therapies are pleasant, inexpensive, nonpharmacologic and effective. For patients with leukemia, the complementary therapies that are always appropriate include mind-body interventions, such as self-hypnosis, meditation, guided imagery and breath awareness. Massage and reflexology (foot massage) decrease symptoms with effects lasting at least 2 days following treatment. Acupuncture is very beneficial for symptom management without adverse consequences."

("Xerostomia, or extreme dry mouth, following head and neck radiation therapy is also very responsive to acupuncture treatments with increased salivation compared with control." [Self-citation].)

It seems that AB would have us consider Integrative "Medicine" as using the nice fresh juicy cowpie as a topping for the apple pie, rather than mixing the two willy-nilly.

Would that happen to be Barrie Cassileth?

Acupuncture for breast-cancer-related-lymphedema...not a good idea:

http://scienceblogs.com/insolence/2013/07/02/acupuncture-and-breast-can…

Lastly, imagine if a doctor were paid by their patients as long as they were healthy and not paid while they were unwell. It would be in the doctors best interest to be a master of health and not a master of sickness.

Isn't that the business model of the health insurance market? The main effect seems to have been to incentivise insurers to deny coverage & treatment to anyone who might get sick.

The mass exodus of patients from this perception of healthcare is its own doing based on its arrogance and performance.
Someone remind me how many million Americans signed up for "this perception of healthcare" once they were given the opportunity

I f you mean the Affordable Care Care a.k.a "Obamacare", it met its goal of enrolling (more than) 7 million people as of the cutoff date of March 31, 2014.

"...Complementary therapies are pleasant, inexpensive, nonpharmacologic and effective...."

Somebody forgot to mention the inexpensive part to all these complementary folk.

Reiki is quackery. Acupuncture? Quackery. Homeopathy? Quackery. “Therapeutic touch”? Quackery. “Energy healing”? Quackery. Chiropractic? Large swaths of it are quackery. Naturopathy? Ditto. That’s the point. “integrating” these modalities with SBM, as “complementary” therapies or whatever is still quackery.

Not to be a trouble-maker or anything.

But when I canvas myself for a position regarding the above, I feel a strong impulse to agree with it, followed immediately by profound unease and uncertainty.

Would you call pet therapy and art therapy quackery? Or....I'm not really sure how best to frame the question. But to use this page here...

http://www.dana-farber.org/Adult-Care/Treatment-and-Support/Patient-and…

...as an example, they offer the following "integrative therapies":

Accupunture
Creative Arts Therapy
Massage Therapy
Meditation
Nutrition/Herb/Food Supplement Counseling
Qigong
Reiki

And they appear to me to be offering them on equal -- or at least comparable -- terms to one another.

So.

I personally think that Reiki is ridiculous, and that "traditional Reiki" is even more ridiculous. It's only been around since 1922.

However, they don't appear to me to be offering it on terms that meet the definition of the word "quackery" better than the terms on which they're offering the creative arts and music.

Furthermore, I myself might very well derive benefits very like those they're describing from not only the arts 'n' music, but also the meditation:

Cancer patients credit meditation for helping reduce anxiety, pain, chronic stress, and depression. Learning to let go of negative or fearful thoughts can help you reach a more peaceful state of mind and feel more physically relaxed.

By finding a peaceful space to focus your attention and control your breathing, you can take your mind and body to a quieter, more comfortable place.

Of course, that's so true in my experience as to be too self-evident for the practice to require guidance by a hospital service-provider. But with or without the service, it's still true. Relaxation is relaxing. There's no arguing with it.

Granted, they do go on to cite research purporting to show that meditation has therapeutic benefits that may not, in reality, exist.

But they do the same for the music therapy. And since I wouldn't say they were promoting magical thinking -- or parting fools from their money, or otherwise crossing any lines that shouldn't be crossed -- by doing that, I don't think I have a justification to say it about meditation (or, ftm, reiki), apart from bias in favor of my own cultural-aesthetic-intellectual preferences.

I mean, it's not as if science understands how or why music has the powers it does, or as if anyone can say with any precision what they are. It's just a matter of general, anecdotal consensus that it has some.

People sometimes make claims for them that others probably regard as a threat to the cultural values they'd prefer to see privileged, in fact:

https://www.youtube.com/watch?v=4avM0qzEF5I

There's no arguing about taste. And maybe this is not such an argument. But I'd be curious to know on what grounds people who hold that it isn't think so. I'm not sure I see any.

______________

(I'm assuming a definition for "quackery" that's either something like (per Wikipedia), Stephen Barret's....

To avoid semantic problems, quackery could be broadly defined as "anything involving overpromotion in the field of health." This definition would include questionable ideas as well as questionable products and services, regardless of the sincerity of their promoters.

...or Paul Offit's:

[A]lternative medicine becomes quackery:
"...by recommending against conventional therapies that are helpful."
"...by promoting potentially harmful therapies without adequate warning."
"...by draining patients' bank accounts,..."
"...by promoting magical thinking,..."

FWIW.)

@ ann:

I used to counsel people who had a serious dx and encouraged them to seek out life-enhancing experiences and to make healthiER choices in daily life so that they would feel better ( which would not necessarily make them BE better)- see movies, listen to music, interact with friends, eat better, avoid alcohol and drugs etc.

I know that woo-meisters will argue that mediation and exercise reduce stress hormones and liberate either neurotransmitters/ endorphins or the *life force* itself ( depending upon how far gone they are) but I think that most sane people will recognise that there's a world of difference between *medicine* and self- care.

I refer to the latter as 'grandmothers' medicine' or 'spa medicine'. Drink tea if you have a cold or get a massage if you feel stress. Exercise to decrease anxiety or weight problems. Sure, all of these activities have physiological effects that can be measured as well as being subjectively experienced by the subject. Most of these activities are also recommended by SBM despite the claims of alties. Most can either be done by the person him or herself or by non-medical personnel.

Woo goes too far when it prescribes these activities as curative or uses them as replacements for therapies that have been found to treat illness through meaningful research; woo also makes diagnoses without benefit of real world methods of measurement and analysis: you may have 'low chi' BUT how could chi be measured since it doesn't exist?

OBVIOUSLY there's much more but I have to get ready to get to my train,

An addendum:

I'm not saying: "Oh, well, anything goes, if the people want it and it doesn't hurt them, where's the harm?" or anything like that.

Ostensibly reputable facilities do sometimes promote quackery and I am immovably opposed to it when they do.

For example: Sierra Tuscon offers brain-SPECT-scanning, a la the Amen Clinic:

http://sierratucson.crchealth.com/treatment/brain-spect/

And while that's not more or less of a pile of absolute crap than reiki is when it comes to demonstrable efficacy/benefit, it is -- by my standards -- quackier. Because there's no extra-medical cultural or human affinity for neuro-imaging. So there's no reason to cater to or accommodate one. They're just mystifying medicine for profit. It's a blight. Moreover, the language they use, while qualified, does definitely suggest that it's science, not art. They speak of "clinical indications," for instance.

But they also offer 12-step -- ie, relating to a "higher power" part of one of their treatment modalities. And I have no problem with that, assuming the usual disregard-if-you-wish terms of 12-step apply.

Woo goes too far when it prescribes these activities as curative or uses them as replacements for therapies that have been found to treat illness through meaningful research; woo also makes diagnoses without benefit of real world methods of measurement and analysis: you may have ‘low chi’ BUT how could chi be measured since it doesn’t exist?

I agree.

My point is that I'm not sure I see how the integrative-therapy (or, in the case of the University of Colarado, "integrative medicine") services of the three facilities linked to on this thread meet those criteria.

the three facilities linked to on this thread

Or four. However many there are.

I guess it's the blanket assertion that offering reiki and acupunture as a complement to cancer treatment in an otherwise legitimate and responsible medical setting is -- in itself, existentially- - quackery that I'm querying.

I see the point with energy healing, homeopathy, and healing touch. Because they have no basis, purpose or function -- conceptually, historically, culturally -- that isn't in direct, oppositional conflict with science-based medicine and/or science.

However, they don’t appear to me to be offering it on terms that meet the definition of the word “quackery” better than the terms on which they’re offering the creative arts and music.

First, they misrepresent reiki:

"Based on the belief that an unseen 'life-force energy' flows through us and helps keep us alive"

No; the reiki power is out there: Per the Usui memorial, "On the beginning of the 21st day, suddenly he felt one large Reiki over his head and he comprehended the truth. At that moment he got Reiki Ryoho."

Reiki is a Japanese technique for stress reduction that is safe, natural, and easy to learn."

Reiki is an occult healing practice that still involves the "transmission" of "secret" signs of "power" and has, moreover, been rejected by the U.S. Conference of Catholic Bishops. Describing it as "Japanese" also suggests that it is used in Japan, although it in fact had to be reintroduced from the West (perhaps predictable, being in the hands of a secret society) in the 1980s and doesn't seem to have caught on.

"In addition to making you feel more relaxed, safe, and secure, a proficient instructor can facilitate energy flow to the areas where you need it most"

If this isn't promoting magical thinking, I don't know what is. It's pure superstition.

Brain-Spectrometry covered here:

http://scienceblogs.com/insolence/2013/07/24/a-board-certification-in-i…

Pet therapy in a hospital? No way, no how, would I ever agree that an acute care hospital should allow pets in patient care settings, especially cancer wards, where patients are undergoing immune suppressing treatments.

I'm not sure what Sierra Tucson has to do with anything, but...

But they also offer 12-step — ie, relating to a “higher power” part of one of their treatment modalities.

"The 12-Step process is utilized as a basis for the treatment programs at Sierra Tucson, and individuals are encouraged to use the 12-Step process in their recovery."

This seems to be more that "offering," despite the backpedaling.

And I have no problem with that, assuming the usual disregard-if-you-wish terms of 12-step apply.

I do, to the extent that it's essentially misrepresented:

"Research has shown that the quality of recovery from all addictive and mental health disorders is enhanced by the many components of the 12-Step Process, such as mutual support, honesty, accountability, acceptance, and spirituality."

Twelve-step programs are essentially cults, with an evidence base that ranges from negligible to actively destructive.

Would you call pet therapy and art therapy quackery?

I have concerns about feel-good, emotional-wellbring activities being described as "therapy", especially in a medical context designed to smuggle them in and create the impression that they improve *physical* health.

The local hospice provides a drinks trolley to the clients, and many terminally-ill patients feel better after a glass or two of decent malt, but they do not call it "alcohol therapy". They provide a Biography Service where volunteers interview clients and lend their transcribing / editorial skills to help them write an autobiography... many clients feel better to see their lives in retrospect, edited to emphasise the plot arc and the closure... but they do not call it Biography Therapy.

Twelve-step programs are essentially cults,

No they're not. They're not even non-essentially cults. They're not even necessarily religious.

with an evidence base that ranges from negligible to actively destructive.

That could be said evidence base for just about every form of alcoholism and addiction treatment there is, sometimes accurately, as with equine therapy (negligible) or Narconon, the descendants of Synanon/The Seed, and countless others (destructive).

Addiction and alcoholism are frequently treatment-refractory, and sometimes lethal. No single thing works for all -- or all that many. And nothing at all works for some.

A lot of people get clean and sober in twelve-step programs with no excess or unnecessary ill effects or suffering whatsoever. Most don't stay that way. But some do. Writing the whole shebang off in the terms you just did is thoughtless, at best. I'm surprised at you.

(No, I'm not. It's not a personal thing. It's just my considered opinion.)

@herr doktor bimler --

I'd rather see a drinks trolley called drinks trolley, certainly.

But I don't know that I'd conclude it had been designed to smuggle a feel-good activity into a medical context and create the impression that it improved *physical* health if it were called "alcohol therapy," assuming that was the only basis to do so that I had.

I probably wouldn't, though.

No they’re not. They’re not even non-essentially cults.

AA and friends are unquestionably cults. There is only The Way. Lifelong dependence on The Program is a necessity. Anyone who brings an addiction to a halt without The Program is a "dry drunk," etc. The rhetoric of "codependence" (which itself was invented out of whole cloth in order to spawn a 12-step program for codependence) is neither more nor less than that of shunning.

I don't have the time or energy tonight to dissect it much further.

They’re not even necessarily religious.

Ceremonially standing in a circle holding hands while reciting the L-rd's Prayer tends to say otherwise.

with an evidence base that ranges from negligible to actively destructive

That could be said evidence base for just about every form of alcoholism and addiction treatment there is, sometimes accurately, as with equine therapy (negligible) or Narconon, the descendants of Synanon/The Seed, and countless others (destructive).

Synanon is not worth mentioning, and equine therapy is hardly an "addiction treatment." Twelve-step programs exist by definition to foster a culture of powerlessness. It is no surprise that predators are attracted to them. Also imperative is the instilling of shame, because it's not really anonymous and there's a pressure to confess.

CBT and pharmacotherapies do not rely on any such weirdness or insist that the underlying problem is an irreparable character flaw. The problem with "just about every form of alcoholism and addiction treatment there is" is that 12-step programs just about are the only form of treatment there is.

Addiction and alcoholism are frequently treatment-refractory, and sometimes lethal.

Yup.

No single thing works for all — or all that many. And nothing at all works for some.

Define "works."

A lot of people get clean and sober in twelve-step programs with no excess or unnecessary ill effects or suffering whatsoever.

Define "a lot of people."

Most don’t stay that way. But some do. Writing the whole shebang off in the terms you just did is thoughtless, at best.

No, it is not.

^ Note that I did not mean include methadone or disulfiram under 'pharmacotherapies'.

AA and friends are unquestionably cults. There is only The Way.

No. That's a ludicrously overstated mischaracterization.

Lifelong dependence on The Program is a necessity.

That too.

Anyone who brings an addiction to a halt without The Program is a “dry drunk,” etc.

And that.

The rhetoric of “codependence” (which itself was invented out of whole cloth in order to spawn a 12-step program for codependence) is neither more nor less than that of shunning.

Huh?

Meaning disconnection, a la CoS?

Are you serious?

I don’t have the time or energy tonight to dissect it much further.

Insofar as I know you from reading your posts here, I'm in awe of your intelligence, ability. wit, heart, soul and integrity.

However, you appear to have been misinformed about what 12-step programs are and how they work by a source that represented the rhetoric and practices commonly used in them in an extremely distorted light.

For one thing, even within a single 12-step program -- ie, within AA or what-have-you -- practice and custom vary enormously by region and group. It's not a monolithic thing, being as it's peer-run and not centrally administered.

But if they're run in the typical spirit, it's not fear-based. There's no leadership. There are no outpoints, brownie-points, sanctions, or punishment. There are no coercive tactics, or even coercive-persuasion tactics.

And -- as they say, quite distinctly -- there are no rules, just suggestions, the only requirement for membership is a desire to stop drinking, yada, yada, yada.. Belief in most of the steps and principles is customary, but disbelieving some of them is common. And, per the framework of the program, both optional and voluntary.

^^I'm talking about the program there. Obviously, I can't vouch for or against every individual group.

People in 12-step recovery sometimes go through a conversion-type stage that's reminiscent of cultiness. But that doesn't make it a cult. They're just converts.

Ceremonially standing in a circle holding hands while reciting the L-rd’s Prayer tends to say otherwise.

Not if you don't have to say it, it has no fixed meaning, and belief in it would be optional even if it did.

It's not, as I already said, even necessarily religious.

Synanon is not worth mentioning, and equine therapy is hardly an “addiction treatment.”

Sierra Tuscon is famous for the latter. Not that I disagree with you.

Twelve-step programs exist by definition to foster a culture of powerlessness.

That's crazy talk. They do not. They exist to provide peer-support groups for people who wish to use them to get clean and/or sober. Primarily.

It is no surprise that predators are attracted to them.

I have no idea what that means. What kind of predation are people who attend 12-step meetings likely to encounter?

Also imperative is the instilling of shame, because it’s not really anonymous and there’s a pressure to confess.

Oh, is there.

Applied by whom? In what way? And what are the rituals whereby shame is instilled?

The problem with “just about every form of alcoholism and addiction treatment there is” is that 12-step programs just about are the only form of treatment there is.

There's not a lot, too often. But there aren't a lot of people with fresh ideas in hand rushing to meet the need, simply out of the passionate desire to work with drunks and junkies for the sheer glamour, joy and ease of the thing.

And even still, 12-step is not regarded as the gold-standard in the addiction-treatment biz, these days, which it still was several decades ago. Harm-reduction would probably take over if 12-step wasn't so much cheaper/easier to get up and running. There's not much that's cheaper and easier than a volunteer-run enterprise.

In any event. It's not a cult, or even cult-like. You're mistaken.

BTW, I'm happy to agree to disagree.

I take it for granted that your opinion is both considered and thoughtful, and that you hold it in good faith.

It's also always possible that I have more to learn. I'd be surprised if that were the case, in this instance. But I can't say that it's never happened before.

Okay? Okay.

ann:

http://www.ncbi.nlm.nih.gov/pubmed/24647726

I will deal with this piecemeal.

The rhetoric of “codependence” (which itself was invented out of whole cloth in order to spawn a 12-step program for codependence) is neither more nor less than that of shunning.

Huh?

Meaning disconnection, a la CoS?

Are you serious?

About which part? "Codependence" had no currency whatever before Melody Beattie, who had no qualifications whatever. Where do you think CODA came from? Shunning is exactly what it's used for. It is held to be morally wrong to help a family member suffering from addiction unless it is to insist upon a 12-step program.

However, you appear to have been misinformed about what 12-step programs are and how they work by a source that represented the rhetoric and practices commonly used in them in an extremely distorted light.

If you think I am speaking from an eyrie or something, you're mistaken. Stating that 12-step programs for addiction are not "monolithic" ignores the fact, at very least, that the U.S. circuit courts have felt no need to observe such niceties.

About which part? “Codependence” had no currency whatever before Melody Beattie, who had no qualifications whatever. Where do you think CODA came from? Shunning is exactly what it’s used for. It is held to be morally wrong to help a family member suffering from addiction unless it is to insist upon a 12-step program.

About every part. It's not an apt comparison.

I should say that I know much less about 12-step for what I believe are termed process addictions than I do about 12-step for substance addictions, apart from anecdotal knowledge. But as far as anecdotal knowledge goes:

That would be news the half-dozen or so women I've known who attended CoDA meetings for the support they got there. All of them were in horrendous relationships with drunks and drug addicts, whom they didn't show the least sign of being told to shun.

Furthermore, if CoDA is indeed run on the 12-step model, nobody in it is in a position to insist on anybody else doing anything, nor is anybody empowered or authorized to enforce the action putatively being insisted upon. Nobody (in fact) is in a position to know a single damn thing about you that you don't volunteer yourself. And there are no routines or procedures in which anybody gives anybody else advice -- let alone ultimatums -- about any matter, issue or question when it hasn't been asked for.

On top of which, membership, attendance, and association are voluntary. There are no fees, and no demands on the time and/or energy of the participants apart from what they elect to expend. And there are no consequences or penalties for not following the advice of another group member. Or, indeed, of all the group members in concert.

But it's somewhat far-fetched to suppose that they'd be acting in concert. It's not that organized. People just show up when they want to attend a meeting. They're under no pressure to do more. And they're under no penalty if they do less.

None of that is how it's done in cults. It takes systematic effort and concentrated, extended periods of time to deprive people of their freely exercised will.

If you think I am speaking from an eyrie or something, you’re mistaken. Stating that 12-step programs for addiction are not “monolithic” ignores the fact, at very least, that the U.S. circuit courts have felt no need to observe such niceties.

As I said, I'm sure your opinion is considered and thoughtful.

I doubt anything the U.S. circuit courts have felt the need to observe is going to convince me that a loosely organized, non-hierarchical, non-coercive program with virtually no rules and no way of enforcing them that's not concerned with either power or money is a cult.

But I'm always open to being wrong.

@Adam G --

Thanks. The word "mindfulness" seems to be everywhere in the mental-healthcare field, I've recently been noticing.

I'm emphatically not saying that 12-step is the best treatment modality. I'm just saying that it's not a cult and that it works well for many people.

Which reminds me:

@Narad --

I don't know the number of people it works well for. But I certainly wouldn't claim that it isn't many times smaller than the number of people for whom it does nothing, if that's the issue.. And....Well. I guess that if you're just disputing that "a lot" is accurate, tell me. I can look it up.

By "works," I mean "helps people to remain clean and sober for long enough to attain whatever object or goal motivated them to." IIRC, most of those who don't become part of the first-year attrition rate get lives and largely drift away in the five-to-ten-year range.

I’m just saying that it’s not a cult and that it works well for many people.

Maybe that's true. I doubt it. My anecdotal experience with these programs is much, much more in line with what Narad has described.

There's no reason for anyone who doesn't want to attend meetings to go to them, unless it's court-ordered.

Once there voluntarily, they're not under any pressure to participate in any, all or some parts of the program if they don't feel like it. There's no process that each newbie has to undergo in order to progress to the goal. They don't have to get sponsors if they don't want them. They don't have to stay with the sponsors they have if they prefer not. They don't even have to open their mouths to communicate with a single, solitary other soul unless they wish to. It's entirely self-determined.

That's not how cults do.

It's an unnecessarily doctrinaire program on paper, as well as -- to a lesser and inherently mutable degree -- in practice. But it's not a cult.

And -- afaik -- its practices are not destructive, per se. Many people find them distasteful and/or intolerable. That's a serious problem. But it's a different problem. It's still not a cult.

Here's another perspective, ann. I hope you do read it through.

http://www.csudh.edu/dearhabermas/aacultbk01.htm

I've read it.

It's an insane misapplication of Lifton (who I am certain would at least agree that it's a misapplication).

I actually care about that more because I don't like to see what cults do misunderstood than because I don't like to see what 12-step programs do misunderstood.

I have strong feelings about cults.

I dislike the "higher power" nonsense of 12-step, nor the scramble by some group leaders to say that "higher power" doesn't really mean "God".

LifeRing has a secular approach to addiction recovery, with an emphasis on personal responsibility and, yes, mindfulness.

It's worth remembering that there are no statistics for whether/how effective AA is, and never will be, by policy, because there's no way to both say "everyone here is anonymous" and usefully track effectiveness. At best, you can have self-reported "I have been attending AA for X amount of time and haven't had a drink" and "but have gotten drunk three times, I'm still working on this." There's no way to connect that to how many people are sitting in the back of the room, got drunk last night and the night before and are going to go to a bar after the meeting, and haven't said a word because they don't feel comfortable doing so. Or with the people who stop going to meetings and are still drinking too much (however they or you would define "too much." Since there's no way to know how effective AA is, just that there are at least a few people who say it worked for them, there's no meaningful way to compare that with other approaches.

I have a friend who credits both Narcotics Anonymous and the love and support of his wife and husband for his having stayed drug-free for many years, as well as giving himself some of the credit. Does that mean that NA works, or does it mean that the key to quitting narcotics is a strong but unconventional marriage? (I'd say it supports the idea that support from other people, including but not limited to spouses and/or other addicts, can help. But that's a much weaker statement.)

Once again:

I am not making any claims for 12-step apart from that it's not a cult and that it helps many people with substance addictions get clean and/or sober.

The truth is that it's such an incredibly underserved population that there's not a whole lot more out there now than there was back in 1935 when Bill W. and his little band of lunatic Xtian drunks decided to help themselves, since no one else was going to.

It's still now what it was then -- someplace for the addicted and alcoholics to go where people will listen and talk to them and where they won't be demeaned, punished, or kicked out.

There's very little more to it than that. There's not really a lot of there there, in reality. It's mostly just people and a lot of simplistic, positive, affirming slogans and mottos.

Despite (or maybe because of) which, someone who's highly motivated for treatment stands a reasonable chance of being able to find a way to piece together a workable program for recovery out of its components, since it's a somewhat anarchic enterprise.

There's not a whole lot else. And that's a shame. But it's not AA's shame. Or NA's. Or anyone's, especially. It's just a shame, same as it is for the legions of people with non-substance-addiction-related psychiatric disorders who don't even have some dumb, annoying, hackneyed out-of-date, sentimental 12-step meeting to go to.

There are an awful lot of addicts and alcoholics who are not highly motivated for treatment, and that's a serious drawback. In case it needs saying.

@Johanna

I dislike the “higher power” nonsense of 12-step, nor the scramble by some group leaders to say that “higher power” doesn’t really mean “God”.

It's not a scramble. That's been the official position of the organization since the get. That's why the preamble concludes by stating that they're not allied with any sect, denomination or creed and neither endorse nor oppose any causes.

In short: "Higher power" means whatever you understand it to mean, by intent and design.

That said, I personally don't much like it either. It's true that I don't have to. But if I did, I think I'd be capable of finding a work-around on the terms of the program as they stand.

@Vicki

I’d say it supports the idea that support from other people, including but not limited to spouses and/or other addicts, can help. But that’s a much weaker statement.

It's a true one, nevertheless.

"get clean and/or sober"

Just what the hell is this "clean" bullshit? Are alcoholics dirty? Do they disgust you and need to be tidied up to be presentable to you? Jesus Haploid Vishnu what a load!

That’s been the official position of the organization since the get. That’s why the preamble concludes by stating that they’re not allied with any sect, denomination or creed and neither endorse nor oppose any causes.

Allow me to first observe that the lone "theoretical" underpinning of all 12-step groups is Bill Wilson's "G-d" moment, which came after four days' "treatment" with Towns's "belladonna cure" and none for incipient delirium tremens. There is now a movement afoot to search for how it "works." This bears a strong similarity to what is known as "Tooth Fairy Science."

There has also been a churning out of what appear to me to be extremely narrow studies (with numerous "corrections" for "confounders") to demonstrate that it's not actually TFS. This appears to be in response to the Cochrane review.

As effectiveness is not the subject at hand, I'll leave it at that and try to get to the explicit matter of psychodynamics and cultishness next.

In order to tie up some loose ends, though, I'll briefly note two things: (1) Regarding "predation," the General Service Board has only grudgingly considered considering the matter, and only in a narrow realm (PDF). (2) With respect to "confession," one well-known mantra is "you're only as sick as your secrets." This derives from Wilson: "Time after time newcomers have tried to keep to themselves certain facts about their lives."

OK, so a précis of the cult argument. One instantiation of "the usual disregard-if-you-wish terms of 12-step" is that The Program itself can substitute for "G-d," right? Let's revisit the original steps in this light:

1. We admitted we were powerless over alcohol—that our lives had become unmanageable.
2. Came to believe that [AA] could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of [AA].
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to [AA], to ourselves, and to another human being the exact nature of our wrongs.
6. Were entirely ready to have [AA] remove all these defects of character.
7. Humbly asked [AA] to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to them all.
9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
10. Continued to take personal inventory, and when we were wrong, promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with [AA], praying only for knowledge of [AA's] will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of [AA], we tried to carry [AA's] message to alcoholics, and to practice [AA's] principles in all our affairs.

That's without interpolation.

Narad --

I tell you again, courteously and respectfully:

You are mistaken to think that AA is a cult.

Unlike 12-step, the subject of cults is one I have strong personal feelings about, as well as considerable first-hand experience regarding, though not as a member of one.

There's no definition or conception of "cult" that means a single damn thing that you can apply to the 12-step model. It simply can't be done.

I mean...

1. We admitted we were powerless over alcohol—that our lives had become unmanageable.
2. Came to believe that [AA] could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of [AA].
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to [AA], to ourselves, and to another human being the exact nature of our wrongs.
6. Were entirely ready to have [AA] remove all these defects of character.
7. Humbly asked [AA] to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to them all.
9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
10. Continued to take personal inventory, and when we were wrong, promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with [AA], praying only for knowledge of [AA's] will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of [AA], we tried to carry [AA's] message to alcoholics, and to practice [AA's] principles in all our affairs.

That’s without interpolation.

Yep.

Do you know how any of those steps is used or understood in practice? Or even if they're used or understood in practice?

Because it really doesn't seem as if you do.

However, I don't want to fight with you. Nor do I want to waste my time trying to convey (guaranteed true and genuine) information to you that you're not interested in hearing.

So let's skip it. If you find the meaning that you're imputing to those words objectionable, I probably don't disagree with you about it, whatever it is.

How's that?

There’s no definition or conception of “cult” that means a single damn thing that you can apply to the 12-step model. It simply can’t be done.

Not only can it be done, it's a commonplace.

How’s that?

If you mean dropping the subject, that's fine. If you mean suggesting that I'm failing to grasp "guaranteed true and genuine" information because I don't seem to "know," then no, but I'll drop it all the same.

In order to tie up some loose ends, though, I’ll briefly note two things: (1) Regarding “predation,” the General Service Board has only grudgingly considered considering the matter, and only in a narrow realm (PDF).

No, no, no. Not so fast.

What you said was that predators were attracted to it.

I don't see anything in that PDF except for an organization acknowledging that the same abuse, exploitation and harassment of women that occurs everywhere in the damn world that men and women frequent is occurring and needs to be addressed.

If that's enough to meet your criteria, you might also say the same thing of skeptics.

(2) With respect to “confession,” one well-known mantra is “you’re only as sick as your secrets.”

Yeah. That doesn't mean you're under any pressure to confess them to anyone, or that you'll be shamed for doing so, which was what you'd claimed.

And it's not (in fact) an exhortation to confess anyway. It's just the twelve-step way of saying "You don't need to live in shame. You have nothing to be ashamed of here."

This derives from Wilson: “Time after time newcomers have tried to keep to themselves certain facts about their lives.”

Uh-huh. So that's your proof that there's pressure on people to confess and be shamed? A not-particularly-well-known or widely quoted sentence from a book that was published in 1939?

That's not very compelling, especially when considered in the context of 12-step meetings:

(a) using a format in which people who don't raise their hands because they have something to say don't even get the opportunity to be pressured to confess, or -- indeed -- to say anything at all; and

(b) the prohibition on cross-talk (responding to what those who do raise their hands have said).

Are you proposing that AA pressures people to confess by giving them the Big Book; murmuring "You're only as sick as your secrets" occasionally while waiting for them to stumble across that sentence; and then sitting back and letting them see if they can resist raising their hands?

Or what?

Do you want to drop it, or not?

If you mean suggesting that I’m failing to grasp “guaranteed true and genuine” information because I don’t seem to “know,” then no, but I’ll drop it all the same.

Yikes. what a repellent thing for me to have said.

Please forgive me.

Believe it or not, I didn't mean to imply, suggest or hint anything negative about you. I was just feeling frustrated and confused. I respect you very much.

Not only can it be done, it’s a commonplace./blockquote>

I've seen arguments to that effect made many times. But they're nearly always mostly rhetorical exercises in reading stuff into AA literature that bears no relation to 12-step practice.

I've never seen a convincing one. Plus I've known so many addicts and alcoholics over the years that it's just ridiculous. So I've also seen enough people go through 12-step recovery to be confident that it doesn't use cult tactics.

Nevertheless, I would definitely read what you were linking to, if I could. But the link is busted.

____________

Again, please accept my sincere apologies. I didn't mean it.

In re: Dropping it.

Sorry. We cross-posted.

I don't know. As you wish.

I appreciate the apology; the matter is forgotten. As the subject is not really on-topic to cancer centers, I'd like to close all these PubMed windows, and I've mentally prepared a comparison to Western misconceptions about Rinzai Zen and Ch'an's losing out to Neo-Confucianism, I think it's best dropped.

I'm perfectly willing to revert to attacking reiki, though.

Vitamin C for cancer: Trying to rise from the grave once again

oracknows — Mon, 10 Feb 2014 03:00:08 +0000

Vitamin C for cancer: Trying to rise from the grave once again

There are certain things that can happen that are the equivalent of the Bat Signal to me; that is, if you can swallow the idea of me being in any way like Bruce Wayne. Call them the Cancer Signal, if you will. When I see the Cancer Signal, I know that I have to head down to the Cancer Cave—wait a minute, that doesn't sound right. Scratch that. In any caes, there are certain studies or stories that basically demand my attention and say, "Blog me, Orac! Blog me right now!!!" Either that, or they're studies that capture my readers' attention, leading them to e-mail me or Tweet at me plaintive requests to blog them. Sometimes I do it. Sometimes I don't. Not every study that interests some of my readers interests me sufficiently for me to put forth the effort to blog about it, and, remember, this blog is all about me. I love that there are a few thousand out there who love what I lay down, but at the end of the day this is all about what interests me. I know that sounds arrogant, but if I started writing about things that didn't interest me that much this blog would rapidly fade into oblivion. My writing would become less interesting, and I'd lose interest, maybe even to the point of giving it up.

Be that as it may, fortunately, the study of the week last week was one that actually did interest me. In any case, this week's Bat Signal consisted of a series of news reports with titles like:

Vitamin C shows promise as cancer therapy (FOX News).
Researchers establish benefits of high-dose vitamin C for ovarian cancer patients (Kansas University Medical Center press release).
Vitamin C injections ease ovarian-cancer treatments (Nature).
Vitamin C keeps cancer at bay, US research suggests (BBC).
Vitamin C May Help Cancer Treatment, Study Finds (NBC News).
IV Vitamin C Boosts Chemo's Cancer-Fighting Power? (WebMD).
Vitamin C as cancer treatment? High doses boost chemotherapy in study (LA Times).

These stories, to varying degrees, miss the point, from utterly missing it to missing most of it. Unfortunately, I confess that I wasn't able to help at least one of them. A reporter happened to leave me a message Tuesday morning, which is my operating room day, and I didn't have time to read the paper and to get back to her before her deadline. Unfortunately, my real job sometimes gets in the way of my being able to help out a journalist. That paper, by the way, appeared in Science Translational Medicine from Jeanne Drisko and Qi Chen from, yes, Kansas University Medical Center, home to one of the more—shall we say?—dedicated centers of quackademic medicine. This indicates to me that STM's standards are slipping. But then, STM did publish a rather credulous paper by our old friend Ted Kaptchuk on placebos less than a month ago; so maybe I expect too much. Clearly STM appears to be looking for more papers on "complementary and alternative medicine" (CAM) or "integrative medicine." Worse, just last week, one of the associate editors of STM, Yevgeniya Nusinovich, hosted a lovefest of a web chat in which Dr. Josephine Briggs, director of the National Center for Complementary and Alternative Medicine (NCCAM), and Dr. Jeanne Drisko, chock full of pro-CAM tropes, distortions, and cherry picking. Among the cherry picked stories, besides the Trial to Assess Chelation Therapy (which Dr. Drisko was a co-author on), was this study on vitamin C and cancer, mentioned near the end of the web chat and the study that I promised to say more about.

A typical story describes the recently published research thusly:

People with ovarian cancer who receive high-dose vitamin C injections are less likely to report toxic side effects from chemotherapy than people who had chemotherapy alone, according to the results of a small clinical trial.

The study, published today in Science Translational Medicine1, was too small to assess whether the combination of chemotherapy and vitamin C combats cancer better than chemotherapy alone. But accompanying work in mice suggests that the two treatments could be complementary.

The results are the latest salvo in long-running controversy over the use of vitamin C against cancer. Early studies championed by Nobel-prizewinning chemist Linus Pauling in the 1970s suggested that vitamin C could help to fight tumours2. But larger clinical trials failed to substantiate those claims3, 4.

With the spin, from another typical story, being:

One potential hurdle is that pharmaceutical companies are unlikely to fund trials of intravenous vitamin C because there is no ability to patent natural products.

"Because vitamin C has no patent potential, its development will not be supported by pharmaceutical companies," said lead researcher Qi Chen.

"We believe that the time has arrived for research agencies to vigorously support thoughtful and meticulous clinical trials with intravenous vitamin C."

Yes, indeed. The same old tropes are there, from the claim that vitamin C has usefulness in treating cancer to the old ascorbate warriors' lament that there's no patent potential in vitamin C, which means that pharmaceutical companies don't want to invest money into doing science and clinical trials on it because there's no profit potential. Of course, I've written fairly extensively about vitamin C and cancer before, using it as an example of how even a two-time Nobel Prize winner like Linus Pauling could fall prey to bad science when he wandered outside of his area of expertise. Every so often these stories come up suggesting that Linus Pauling has somehow been vindicated and how vitamin C is the greatest thing for cancer patients since surgeons first discovered that some cancers could be cured by cutting them out. Inevitably, I have to throw cold water on such claims. No, Linus Pauling has not been vindicated, and, no, vitamin C for cancer is not all that great. It might even be harmful.

Also, no, contrary to what critics say, I'm not close-minded about vitamin C and cancer. Unlike so many "alternative" cancer treatments, it's actually a chemical and, at the doses used by alternative cancer practitioners, a drug. There's even a (very) weakly plausible mechanism by which it might work. However, in vitro, the concentrations required to provide even a whiff of a hint of antitumor activity are ridiculously high, and the same is true in animal models. Let's just put it this way. Imagine a pharmaceutical company had developed a compound with properties identical to that of vitamin C and could thus own the complete patent on it as a drug. Given the ridiculously high concentrations and doses required in preclinical models to demonstrate a hint of antitumor activity against , that pharmaceutical company would probably retire that compound before even the animal model stage because, as I like to put it, getting any useful anticancer activity out of it would be such a long run for a short slide. A good drug for cancer is, at the very minimum, active at low or reasonable concentrations against the cancer cells being targeted, and vitamin C fails miserably on that count. Worse, there are at least indications that in some cases vitamin C might interfere with chemotherapy.

So does this study change my opinion? Not really. At best, it suggests there might be some utility for ascorbate (vitamin C) against ovarian cancer, but that ascorbate therapy for cancer still remains at best a long run for a very short slide right into the gloved ball of reality for a third out. (OK, I'll stop with the baseball analogies.)

The dubious reasoning begins right in the first paragraph, with the authors' justification for "re-examining" ascorbate as a cancer therapy. Basically, they point out that the pharmacokinetics of oral ascorbate dosing is different from intravenous dosing, to the point where it is possible to obtain serum ascorbate concentrations of 10 mM (millimolar). To give those of you who aren't chemists a rough comparison of just how high that concentration is, most cancer drugs have active concentrations in the nanomolar (nM) to micromolar (uM) range, in other words, a thousand-fold to a million-fold lower than 10 mM. For example, the IC₅₀ (the concentration that leaves only 50% of cells alive) for paclitaxel is in the 2.5 to 7.5 nM nM range, depending upon the cell line, and 50 nM is considered a good, effective therapeutic concentration. You get the idea. You need a lot of ascorbate:

By contrast, when ascorbate is injected intravenously, tight control is bypassed and pharmacologic concentrations of ascorbate are established until excess ascorbate is excreted by kidney. Plasma concentrations greater than 10 mM are safely sustained in humans for ~4 hours (10–13). When patients have normal renal function and glucose-6-phosphate dehydrogenase (G6PD) activity, toxicity is minimal even with intravenous doses as high as 1.5 g/kg, equivalent to 105 g for a 70-kg person (2, 12). These data indicate that intravenous administration of pharmacologic ascorbate doses is safe and similar to drug administration. Therefore, the effect of ascorbate in cancer treatment is worth reexamining.

These are huge doses, consistent with previous experiments in mice with a xenograft from an ovarian cancer cell line (Ovcar5) in which 4 g/kg of ascorbate was administered twice daily for a total of 8 g/kg/day. The result was an inhibition of xenograft growth of around one-third after 30 days. Results for a pancreatic cancer cell line and a glioblastoma cell line were only marginally better.

The authors did several cell culture studies in which ovarian cancer cell lines were treated with ascorbate and various chemotherapeutic agents. The authors reported an IC₅₀ of between 0.3 and 3.0 mM, which is still incredibly high for an anticancer drug. The authors blithely write that this is "easily achievable" with IV ascorbate. Maybe so, but given the quantities involved, if you're going to use a drug that requires such high plasma concentrations to have activity, that activity had better be awesome. None of the activity shown in this paper can be characterized as being particularly impressive. Worse, the authors, despite testing several ovarian cancer cell lines, only tested one non-tumorigenic immortalized ovarian line, HIO-80, and, finding that the IC50 to kill HIO-80 cells was much higher than all but one of the other cell lines (SHIN3), proclaimed a high degree of specificity for cancer. Moreover, HIO-80 cells are hardly "normal." They likely contain BRCA1 mutations. Finally, the authors only used one assay for proliferation, the MTT assay. This particular assay is very popular (I use it in my lab not infrequently) because it is faster and easier than counting viable cells and also allows for large experiments using 96-well plates. However, the MTT assay depends on the metabolism of cells to produce a dye that is detected. The amount of light absorbance due to the dye is assumed to be proportional to the number of viable cells. Usually, this assumption is reasonable accurate, but lots of things can interfere with this and render that assumption incorrect. For instance, one wonders if very high concentrations of ascorbate can interfere. I'd want to see a control demonstrating that the MTT results correspond to cell number.

In other words, if I were a reviewer for this paper, not so fast, I'd have said. I want to see the results for at least a couple of more non-tumorigenic cell lines and a control validating the MTT in the presence of so much ascorbate (even if just a reference) before I'll let you conclude that the effects of ascorbate are highly specific for cancer over normal ovarian cells. At the very least, I wouldn't have considered it unreasonable to ask for a couple more non-tumorigenic ovarian epithelial cell lines to be tested.

In any case, the authors also did some mechanistic studies, the results of which were consistent with the activity of ascorbate in cancer requiring the production of peroxide (H₂O₂), as H₂O₂ scavengers blocked the effect. They also did a series of experiments that indicated synergy between ascorbate and carboplatin, a common chemotherapy drug used in ovarian cancer. One area that, as a reviewer, I'd have gotten on the authors' case was the series of xenograft experiments using ovarian cancer cell lines implanted under the skin of immunodeficient mice, specifically this part:

Two-tailed Student’s t test was performed for comparison of treated groups to control group in the cell and animal experiments, as well as for toxicity comparison between chemotherapy group and chemotherapy + ascorbate group.

No, no, no, no, no! This is some pretty basic stuff here. There are eight different experimental groups, and the authors didn't control for multiple comparisons, as far as I am able to tell. Pair-wise two-tailed t-tests are not the correct statistical test for determining statistical significance in such a case; likely some form of ANOVA would be, given that the dataset consists of tumor weights and volumes of ascites, the latter being a common estimate of ovarian tumor burden in mouse models. Some form of ANOVA, likely factorial ANOVA, would have been the proper test, given that there are combinations of three drugs being used. Whatever the correct test is (and I'll leave that to the statisticians out there), I know that Student's t-test isn't it, and that using Student's t-test will often produce "false positives" that appear statistically significant but aren't.

All of this, however, is the warmup to the part of the study that got it noticed, namely the clinical trial. Without the clinical trial, this would have been yet another in vitro and animal study of high dose vitamin C that provokes a collective yawn throughout the scientific community. The clinical trial itself, was a randomized prospective phase I/IIa clinical trial, which means that the trial was designed to combine an evaluation of toxicity with a pilot study to evaluate efficacy and safety. Its primary objective was to "determine the safety of high-dose intravenous ascorbate when combined with first-line chemotherapy paclitaxel and carboplatin in the treatment of advanced-stage ovarian cancer," along with evaluation for toxicity. Consequently, the two groups were (1) standard carboplatin plus paclitaxel (Cp + Pax) and (2) carboplatin plus paclitaxel plus ascorbate (Cp + Pax + AA) according to this design:

Ascorbate dose for the Cp + Pax + AA arm was established via dose escalation initiated at 15 g per infusion titrated up to a therapeutic range of 75 or 100 g per infusion, with a target peak plasma concentration of 350 to 400 mg/dl (20 to 23 mM) (12, 13). The ascorbate infusion was given at a rate of 0.5 g/min, and 400 mg of magnesium chloride (Wellness Pharma) was supplemented into each infusion. Once the therapeutic dose was established, the Cp + Pax + AA group received ascorbate two times per week in conjunction with chemotherapy for 6 months, and injectable ascorbate was continued for another 6 months after chemotherapy completion.

In addition, the authors noted:

Two subjects voluntarily withdrew from the Cp + Pax arm before treatment commenced because they wanted intravenous vitamin C, and they were excluded from data analysis. Two subjects were removed from the Cp + Pax + AA arm because they were noncompliant with tobacco use, and one was removed from the Cp + Pax + AA arm after in vitro cytotoxic assays detected that her tumor cells were resistant to all chemotherapy. These three subjects received doses of chemotherapy and ascorbate, so their adverse events were counted, but they were excluded from the survival report (table S3). Double blinding was used at enrollment and randomization, but was not maintained during the treatment because no placebo control was used.

So what we have here is a small clinical trial with a 19% dropout rate that wasn't even blinded. It reported zero difference in overall survival (both were, as one would expect for ovarian cancer at this stage, abysmal), and zero statistically significant difference in time to relapse/progression. In all fairness, there would have had to have been an enormous effect to produce a statistically significant effect on survival or progression in such a small study, but these are the two "hard" endpoints that would be least affected by the lack of blinding, although one notes that time to progression could be affected by lack of blinding when the definition depends on interpreting scans. It's also hard not to note that the differences in toxicities are all in the mildest reported toxicities, grades 1 and 2 (out of a scale of 1 to 5, with a score of 1, which denotes mild toxicity that requires no intervention to 5, which is death). There were no statistically significant (or even close to statistically significant) differences in toxicities graded 3 or 4, which are the most troubling kind. Take a look at the graph:

Then, when the authors broke it down, this is what they found:

Notice the types of complaints with the biggest difference: gastrointestinal (which usually includes symptoms such as nausea, abdominal pain; dermatology, which usually includes itching and rashes of various types); pulmonary, which often includes symptoms of shortness of breath, cough, and the like, and renal/genitourinary, which is the only one that's less objective. So, basically, what we have is a study that found no benefit in overall survival or time to progression (not unexpected for such a small study). More importantly, contrary to the way it was trumpeted to the press, the decrease in adverse events actually observed was limited to the least serious adverse events (grade 1 = minor, causing no limitation of activity, no intervention required; grade 2 = moderate, some limitation of activities, minimal intervention indicated) with the most potential to be subject to reporting bias, which in the context of a trial that is not blinded makes the difference reported probably meaningless. In other words, this was probably a negative study, a long run for a short slide, indeed. (Sorry, couldn't resist. Again.)

Not that any of this stops Dr. Drisko from saying things like:

"We now have a better understanding of vitamin C's anti-cancer action, plus a clear safety profile, and biological and clinical plausibility with a firm foundation to proceed," said researcher Dr. Jeanne Drisko, director of the integrative medicine program at University of Kansas Medical Center. "Taken together, our data provide strong evidence to justify larger and robust clinical trials to definitively examine the benefit of adding vitamin C to conventional chemotherapy."

"Firm foundation to proceed"? You keep using that term. I do not think it means what you think it means. All Dr. Drisko has shown is that there is no difference in survival between the group receiving high dose ascorbate and the group receiving standard of care and that, putting the very best possible spin on the data, maybe adding ascorbate to carboplatin and paclitaxel in the treatment ovarian cancer might decrease the most minor side effects of chemotherapy; that is, if there wasn't reporting bias due to the lack of blinding after the randomization.

I'm not impressed. Neither should you be.

oracknows Sun, 02/09/2014 - 22:00

Tags

cancer

Clinical trials

Kansas University Medical Center

ascorbate

ascorbic acid

Jeanne Drisko