The return of the living Choprawoo

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I was originally planning to do a real science post today. Indeed, there are at least two or three interesting studies that have been released in the last month or two that I’ve been meaning to write up, you know, to lose the snark and make this a real Science Blog. True, having a little fun deconstructing the silliness of homeopaths or antivaccinationists is educational (not to mention entertaining and so fun). However, very so often I feel the need to get serious, and over the last couple of weeks I think I let the snark run a bit more wild than usual, not counterbalanced as much with more scientific fare. I thought it was time to rectify that. Too bad it’ll have to wait at least one more day, as I was just too drained last night after a day in clinic to do the requisite work of critically reading one of the papers.

Fortunately (or unfortunately, depending upon your point of view), Woomeister Supreme Deepak Chopra’s been busy again. Thats right, he’s baaack, this time with what is thus far a two part post on that repository of everything New Age, antivaccination, and woo, The Huffington Post, entitled The Future of the Body. Here’s Part 1 (mirrored here), and here’s Part 2 (mirrored here). I was tempted to use my usual response to Choprawoo and leave it at that, but then I got annoyed at Chopra’s downright silliness:

A tide of media articles over the past few years has made it clear that medicine is putting almost all its future hopes on genetics. But a small study from UCLA offers an intriguing alternative, one that could be just the tip of the iceberg. Researchers found that children and teenagers who described themselves as positive thinkers had higher thresholds of tolerance for pain. On the other hand, young subjects who had learned less positive coping skills (such as worrying about problems or turning to someone else for help) were less able to tolerate the application of pressure or heat to the skin, which was how pain was measured in the laboratory.

The significance of these findings is that psychological attitudes changed basic physical sensations. It had already been shown that we don’t all respond to pain alike. When asked to rate pain on a scale of 1 to 10, people who are subjected to the same stimulus come up with far different reactions. What feels like a 1 on the pain scale to one person can feel like a 6, 7, or higher to another. Instead of being simply a physical variation, the new research suggests that personal interpretation is involved. Yet to the person feeling the pain, this isn’t a subjective event. The degree of discomfort is completely real.

Yawn. What an amazing insight. Chopra has discovered that people don’t all respond to pain in the same way and that psychological factors can alter how severe people perceive their pain to be. This is only something that we’ve known for centuries and that psychologists have been studying for decades at least. There are even observations on how cultural background influences how people react to pain, from stoic to what seems to be a low pain threshold. Every surgeon who’s ever operated knows this. Yet, Chopra seems to view this observation as some sort of amazing insight that somehow challenges that evil reductionist genetics. This is as bad as Chopra’s last foray into genetics he had the chutzpah to label The Trouble With Genes, which still stands supreme as perhaps the dumbest thing ever said about genetics. Unfortunately, he appears to be trying to surpass it. He’s also confused about the subjectivity of pain. Pain does have a significant subjective compenet, yet Chopra seems to be arguing against a strawman argument that modern medicine assumes that pain’s subjectivity must mean that the pain people feel isn’t real. While there may be a few physicians left who think that way, most in my experience do not. Of course, if that were the only thing that Chopra got wrong it might not be so bad, but he has to keep plunging into the woo to find only the silliest bits.

Chopra then takes this insight and runs with it, comparing the subjective influence of our emotions and psychology on how we perceive pain to the Tummo monks:

Why is this the tip of an iceberg? I was reminded of Tummo, an ancient form of Tibetan meditation that originated in India as a yogic practice. Buddhist monks who practice Tummo are able to withstand extreme cold without discomfort or bodily harm. Clad only in a thin layer of silk, they can sit all night in ice caves in the Himalayas or on the surface of a frozen lake. Long considered a legendary skill, Tummo has been verified by Western researchers, who discovered in the 80s that the monks are raising their body temperature by up to 8 degrees Centigrade, or 14 degrees Fahrenheit. In essence, they are controlling a feedback loop in the body that is normally automatic. A region of the brain known as the hypothalamus is responsible for regulating body temperature, but in this case the monks are inserting their own intention, and what was once automatic becomes voluntary.

The Tummo monks are a rather interesting case, but the sorts of things Chopra ascribes to them are a bit hard to believe. For one thing, increasing body temperature that much would pretty much denature many of the proteins in the brain. In fact, even Herbert Benson, the man at Harvard who has been studying these monks doesn’t claim that they raise their body temperature by that much. What he claims is that the raise the body temperature of their fingers and toes that much, which would be an indication of increased blood flow to the extremities, which is a very different thing indeed. As a physician, Chopra should know that. At best this is an indication that it may be possible to control the autonomic nervous system more than we thought. Indeed, this study was published in Nature in 1982; however, I’ve yet to see any followup published by Benson about the monks, except for in an article in the Harvard Gazette. Given the poor quality of evidence presented, suffice it to say that I’m skeptical about whether this ability is truly such a high degree of control of the autonomic nervous system or whether it represents conditioning to cold temperatures, such the “polar bears,” swimmers who like to take a dip in the middle of winter.

Even if all the claims were 100% true, it would not mean that genetics or reductionist science would be invalidated. After all, if people can control their autonomic nervous system, the mechanism would have to be mediated by proteins, which are coded by–yes, indeed–genes. Chopra exaggerates when he claims that all therapy is becoming gene therapy, but he’s too obtuse to realize that, even if every one of his woo-iest mind-body claims were true, it would not in any way invalidate genetics, genomics, proteomics, or any other -omics. Chopra then takes it to ridiculous extremes:

Yet we have twenty years of mind-body research to suggest otherwise. Beginning twenty years ago, it was found that psychotherapy helps women cope with breast cancer, not just in terms of feeling better but actually increasing survival rates. When terminal cancer patients were divided into two groups, those that had no psychotherapy and those who met for group sessions once a week to discuss their feelings, the longest term survivors were all the in therapy group. Before that, the noted editor Norman Cousins had written about the reduction of tumors in cancer patients who used visualization techniques, often as simple as seeing their tumors being buried under a blanket of falling snow until they disappeared.

Dr. Chopra’s a bit behind on the medical literature. The latest evidence, as I discussed about a month ago, does not support the idea that psychotherapy, group therapy, or a positive attitude prolongs survival in cancer patients. Chopra’s just plain wrong here, and the studies that he cites were not well done. More recent research, with better designed trials, refute them. None of this mean that a positive attitude isn’t a good thing, nor does it mean that a positive attitude won’t make your battle with cancer, if you are unfortunate enough to get it, easier to deal with Just don’t expect it to prolong your life at all. Contrary to Chopra’s grandiose claims, while it is true that for subjective measures (like pain), the placebo effect can result in as much as a 30% response, for objective measures (cancer survival, for example), there is no detectable effect that is attributable to placebos. Chopra might have a point that mind-body techniques may be cheaper, but I wouldn’t trust my life or health with them when it comes to curing diseases.

In part 2, Chopra takes his observation that people react differently to pain and generalizes it:

In the East it is more easily accepted that each patient is unique, and therefore one cannot expect that the same therapy will lead to the same results in everybody. One sees this in the placebo effect, also. You can give inert sugar pills to cure pain, and the pain will go away in some patients but not others. To a Western-trained physician this lack of reliability undermines the treatment’s credibility. Medical schools teach their students to expect a shot of penicillin or an appendectomy to lead to a cure as reliably for patient A as for patient B.

In practice there is no such thing as complete reliability, however, and one must consider how many patients die on the operating table or suffer extreme side effects from drugs. There is also the problem that drugs become less effective over time — the phenomenon known as tachyphylaxis — and that “super germs” develop in hospitals, causing a serious rise in illness and death caused by the treatment — a phenomenon known as iatrogenic disease.

This is such a blatant straw man of how scientific medicine works that no crows are to be found anywhere near that part of the Huffington Post. No physician expects “complete reliability. Chopra would know, if he paid any attention at all during medical school, that what we’re talking about is probabilities. “Reliability” means a high probability that a treatment will work and as narrow range of variability in responses between patients as is achievable. Besides, at least one major reason that there are variabilities in responses to treatments is genetics. Indeed, we are reaching the point in cancer therapy where we can predict the probability of a response to chemotherapy by doing genomic tests, just as we are now estimating the probability of developing various diseases by similar tests. Even if Chopra’s “mind-body” medicine worked, it would be pretty useless without some reliable (there’s that word again) way to figure out which intervention will work for which patient. Moreover, Chopra can’t help but bring up that favorite alternative medicine trope about iatrogenic illnesses and injuries, but, as with most woos, he doesnt’ weigh benefits in terms of diseases cured versus risks of injury. Of course, with placebos, the risk of injury from the placebo can be, depending upon the placebo, close to zero. However, the chance of cure is also zero, and using modalities known not to produce an objective effect (placebos) raises grave ethical concerns.

What it all boils down to thus far for Chopra is using biological variability among people as an excuse for justifying either combining unscientific treatments with scientifically demonstrated treatments or choosing them instead, finishing with a huge straw man yet again:

I’ve come to feel that the argument will never be settled until we accept a fact of nature: everyone has a unique response to disease. No single treatment can be expected to cure or prevent illness with complete reliability, and even if Western medicine is right to claim that a drug like penicillin works more often than any alternative, Eastern medicine can point to drug intolerance, side effects, and expense as considerable drawbacks…Therefore, each of us needs to consider our own bodies, our own life history, and our own susceptibility. Mainstream medicine constantly tries to sell its one-size-fits-all position, and it shouldn’t. For decades all patients with high blood pressure were put on reduced salt diets that they found hard to tolerate, despite the fact that over 80% of people are not salt sensitive and can eat as much salt as they want. Over that same period low-cholesterol diets were pushed for all patients at risk for premature heart attacks, even though the connection between the cholesterol you eat and the cholesterol in your blood varies widely. To claim that there was a simple correlation was bad science. Meanwhile, the strong correlation between heart attacks and psychological stress was pursued with much less enthusiasm, if at all. Today, of course, newer and better drugs are meant to solve all problems.

Once again we hear the claim of “individualized” treatment unlike the allegedly “one size fits all” nature of scientific medicine. As I’ve said before, I find this particular claim by woomeisters like Chopra to be risible. For one thing, certain “alternative” modalities rely on ascribing a single cause to a wide variety of diseases of unrelated pathogenesis. (Hulda Clark claiming to be able to cure cancer, AIDS, and even “all diseases” by killing liver flukes with her “Zapper,” anyone? Imbalances in qi?) But, more importantly, this fetishizing of “individualization” by advocates of “alternative” medicine such as Deepak Chopra, is more an excuse not to have to come up with concrete, testable diagnostic criteria for diseases or conditions or to have to show actual objective efficacy of their treatments through the scientific method. Fuzzy thinkers like Deepak Chopra often invoke biological variability between individuals more when it is convenient to do so than as a real substantive argument, particularly when a therapy is most likely due to the placebo effect, as Chopra all but admits that his “mind-body” medicine is. In reality, the emphasis of woomeisters like Chopra on “individualization” consists of little more than buzzwords. There’s no evidence that alt-med does any better at treating the “whole patient” than conventional medicine and considerable evidence that, by lumping many diseases of unrelated pathophysiology together and using the same treatments for them, alternative medicine’s claims of “individualization” means the freedom to keep trying stuff until the patient’s symptoms get better on their own. In many cases, the “individualization” of treatments claimed by advocates of alt-med is just fancy way of saying, “We make it up as we go along.”

Worse, his claims smack of blaming the victim of disease. An ugly implication lurking just beneath his emphasis on claiming that the mind can heal the body in such spectacular ways is that the person who remains ill and cannot “heal” himself must lack the will to do so.

ADDENDUM: Heh. Mark over at denialism blog apparently had the same idea about this Choprawoo that I did. Great minds think alike, I guess.